Figuring things out
Figuring out the pathway to treatment when you, or someone you love, has an eating disorder can be a crash course in understanding the public health system, or the world of treatment and psychotherapy. It can be daunting and confusing. This guide will hopefully give you some knowledge that will make this pathway a little less challenging and help you to take the necessary steps towards treatment and recovery.
One of the key points to take on board is that when it comes to treatment and finding a treatment modality that works, there is ‘no one size fits all’. Every person who has an eating disorder is different, and while there are elements and aspects of eating disorders that are universal, the way in which a person finds their way out of an eating disorder is subjective and at all times we must keep an open mind.
An open mind also allows us to try something different if what we are doing isn’t working. Very often people say “I tried counselling and it didn’t work.” Keeping an open mind allows us to reframe this and say, “The counselling I tried didn’t work for me so I need to try something different, somebody different, or a different type of therapy”.
Our hope is that this guide prepares you to seek out and find a treatment that works for you or the person you care about. Our years of experience listening and supporting people in treatment and trying to recover from an eating disorder has taught us that recovery is possible and that if something hasn’t worked, it is not that the person can’t recover it is that the type of treatment wasn’t right for them at that time. Try not to give up. If something does not seem to be working, then we hope this guide, and our other information leaflets, will give you the confidence to think about why, ask the clinician the questions you have, and in some cases to try another approach.
Public treatment pathways for adults (those over 18 years old), and for children and adolescents differ in relation to the treatment team. In both cases the GP is the gateway into the treatment and assessment teams, and from there the basic pathways are the same, except that one is specific for adults and one for children, and the therapies that are offered differ according to the age of the person.
Generally there are two treatment pathways for eating disorders, in Ireland, a public pathway and a private pathway. However, separating the two pathways in this way, tends to limit our choices, and also tends to assume that the private pathway is very expensive, which is not always the case. Keeping an open mind, and not assuming that taking one pathway precludes a person from trying the other, can be very important, as in many situations they intertwine and can work well together, as well as working well separately.
For both adults and children/adolescents, the GP is the gateway into the public treatment and assessment teams. From this point the basic pathway are similar except that one is specifically for adults and the other for children and adolescents. The treatment approach offered differs according to the age of the person.
Another key point to keep in mind, is that an eating disorder is not just a mental health issue. All eating disorders pose serious physical and medical risks to a person therefore no matter which treatment modality is chosen, it is crucial that the treating clinician is cognizant of this, and has the experience and expertise to work holistically, allowing for the medical and physical aspects to be monitored. And vice versa, that if the treating clinician is a medical professional that they also recognise that the mental health aspects require experience and expertise to treat. When deciding on where to go, it is useful to know that it is recommended that people with eating disorders have access to advice from a consultant psychiatrist, a psychotherapist and a dietitian, as well as a GP, so that all of their needs can be addressed. These are the person’s ‘team’ and it is important that these professionals communicate with each other.
A final point to consider before delving into the world of treatment, is that research suggests that a strong and trusting therapeutic alliance (relationship) between the person and their treating clinician is crucial for treatment to be successful, regardless of the modality of treatment approach. While certain treatment modalities are researched and have a growing body of evidence supporting their effectiveness, it remains crucial to form a strong and trusting alliance with the treating clinician for the treatment to be effective. This relationship is key to achieving long lasting and sustainable change.
Note: the public pathways for adults and for children is an evidence based stepped model of care, which means that based on an assessment the person enters at a particular level of care , based on the their clinical needs (outpatient, day patient, inpatient) and can move up (as needs and risks increase clinically), and move down (as the patient improves and needs / risks decrease clinically) as needs be.