Teachers can save the lives of pupils suffering from eating disorders, provided that they act wisely, a new guide claims.
Pooky Knightsmith, of King's College London's Institute of Psychiatry, spoke to 800 members of school staff and 500 pupils in her research into the handling of eating disorders at school. Her findings have been published as a new book, intended to help teachers deal with suspected eating disorders among their pupils.
More than 1.5 million people in the UK are living with an eating disorder, according to a parliamentary report published in May this year. And a 2011 YouGov poll showed that a quarter of children aged between 7 and 18 consider themselves overweight; 26 per cent have skipped a meal to lose weight.
But, Knightsmith says, teachers are particularly well-placed to detect the early signs of eating disorders. Research conducted by eating disorders charity Beat has shown that children are nine times more likely to talk to a teacher about an eating disorder than they are to approach a parent.
And school staff are more likely to notice a change in a pupil after a school holiday than their family might during weeks of constant contact.
"I don't think it's going too far to say my teacher saved my life," one pupil says.
Unfortunately, Knightsmith adds, research shows that pupils are often unwilling to express their eating disorder anxieties to members of school staff. In her guide, she examines the reasons for this and outlines what teachers can do to help remedy the situation.
"Our teachers don't have offices or anything, so it's virtually impossible to speak to a teacher in private," one teenager told her. Knightsmith therefore recommends that teachers set aside time each week when they will be available in their classrooms at breaktimes. Pupils should be made aware of this, and be permitted to request a particular appointment.
Form tutors should also make a point of speaking privately to each member of their tutor group every half-term. And they could set up an email account or drop-box, so that pupils are able express concerns anonymously.
Other pupils worry that they will make the effort to approach a teacher, only to be told that they should be speaking to another member of staff instead.
"Have a policy that states any member of staff can handle a disclosure," Knightsmith says. "That way it is up to a pupil to decide who they feel comfortable talking to."
She recommends that schools establish clear guidelines about how disclosures will be handled. These can then be discussed during tutor group periods or PSHE lessons. And, she adds, parents should not be involved without discussing the situation with the pupil first.
Broaching the subject
Teachers also need to be careful when broaching the topic of an eating disorder for the first time. Under no circumstances should they tell a pupil: "I'm worried that you might have an eating disorder." The eating disorder label may cause the pupil to panic or become unnecessarily scared.
The best way to express concern is to engineer a situation in which pupils feel that they have instigated the conversation themselves. For example, a teacher could ask a pupil to stay behind to discuss some recent homework.
After actually discussing the homework, the teacher could then add a casual, "Are you OK? You seem awfully quiet," and wait for a response.
Knightsmith suggests asking open questions, such as "What are your biggest concerns at the moment?" or "I've noticed that you've not been yourself lately. How can I help?"
"Listening is the very best thing you can possibly do," she says. "Just letting them pour out what they're thinking will make a huge difference."
Teachers may find it disturbing to hear the graphic details of an eating disorder. However, it is vital to respond calmly. Do not take notes or openly check the time. And, at the end of the discussion, talk about what will happen next.
"I was a bit worried about what would happen next, but it was a relief to finally talk about it all," one pupil told Knightsmith. "It meant a lot just to know someone cared."
10 tips for effective listening
1. Make enough time: do not embark on a conversation you will not have time to finish.
2. Remove physical barriers: sit next to or opposite the pupil, without a desk between you.
3. Maintain eye contact, to the extent that it feels comfortable.
4. Minimise distractions: turn off your phone and computer.
5. Keep an open mind. Make no assumptions - just listen.
6. Make listening noises: small responses that show you are paying attention.
7. Ask exploratory questions, showing that you have understood what the pupil has said and want to know more.
8. Do not be afraid of silence. Allow the pupil time to think.
9. Observe the 8020 rule: if the pupil is talking for less than 80 per cent of the time, you need to redress the balance.
10. Paraphrase the pupil occasionally, to prove that you are listening.
How to end the meeting
- Confiding in someone takes a great deal of courage, so make it clear that you are proud of your pupil.
- Make it clear that the pupil is no longer dealing with the problem alone.
- Summarise what you have discussed, to ensure you understand the pupil's main concerns.
- Talk about aims for recovery, acknowledging that there is no quick fix.
- Talk about the fact that you hope to work with the pupil and other key people, in order to help tackle the problem.
- Agree the next steps. Make sure they are simple, and that the pupil understands the need for these actions.
I don't think it's going too far to say my teacher saved my life
Knightsmith, P. Eating Disorders Pocketbook (2012). Teachers' Pocketbooks.
Eating disorders advice from Pooky Knightsmith. www.eatingdisorders advice.co.uk
Institute of Psychiatry, King's College London.
Beat, an eating disorders charity.