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The highs and lows of being a patient with an eating disorder in emergency care

Service user James Downs on how compassionate nurses made him feel worthy of being cared for

Service user James Downs on how compassionate nurses made him feel worthy of being cared for


Picture: iStock

Like so many people experiencing mental health problems, my story of living with an eating disorder since my teens has been long and complex, with many ups and downs.

At its best, I have been able to work with incredibly supportive therapists to help build a life worth living. At its worst, the physical complications of anorexia and bulimia have threatened my life.

At other times I have been so despairing that I have tried to end my own life.

Real risk of dying

In these crisis moments, when I have been at real risk of dying – eating disorders have some of the highest mortality rates of all mental health problems in the UK, according to Beat Eating Disorders, an organisation that offers help, advice and support – emergency departments (EDs) have been the net that has caught me.

‘The nurses who helped me asked how I was and treated me with the care that I needed to establish enough trust to talk’

Even when all other support failed, I have been lucky to have had lifesaving treatment for low potassium more times than I can count. I have been lucky to have been saved from an overdose, even though I was initially angry that my attempt to end my own life was unsuccessful.

But these crucial moments in my recovery journey were about much more than having my body fixed, my blood stabilised or my hydration restored.

Yes, I needed treatment and I needed it fast, but I wasn’t just a machine needing fixing. I was at my most vulnerable: a highly distressed person experiencing psychological as well as physical pain.

Rock bottom

While these times are dramatic and fraught with risk and danger, they are also times of opportunity. There’s something to be said for the phrase ‘you have to hit rock bottom for things to get better’, yet it depends on what happens at rock bottom.

There have been occasions when, in the ED, I have been told by staff that I am selfish for having an eating disorder, that I should take more responsibility or that I need to choose to get better and be grateful for what I have.

There are many reasons why people end up in an ED in a mental health crisis, but usually it is because they don’t have enough help to recover in the first place. The services that should be supporting them aren’t taking their own share of the responsibility.

When ED staff have treated me like I was badly behaved or a problem to fix, they have missed the one thing that I wanted and needed: to talk.

I am amazed that I was able to leave hospital so many times, including after an attempt to take my own life, without a mental health assessment. Sometimes I was never even asked how I was feeling.

These conversations didn’t require specialist training, they require the most human of skills – listening, showing care and compassion.

One of the last and best ED experiences I had in a crisis was when I had a stomach tear from binge eating and vomiting.

Expert prescribing and monitoring

Yes, I needed all the careful medical attention I received, the expert prescribing and monitoring. But what I valued the most was the way these things were done; I wasn’t treated like a problem or a waste of time.

The nurses who helped me asked how I was and treated me with the care that I needed to establish enough trust to talk.

‘Through showing compassion – not trying to fix mental health problems, but simply listening – nurses can make the world of difference when people need it the most’

I knew they wouldn’t be able to fix my problems, but through listening and showing that they cared, I felt like my experience was real and valid, and I left the hospital feeling more motivated than ever to get better.

Those nurses showed me that I was worth being cared for, and that included looking after myself.

In a high-pressured fleeting moment, being able to strike a therapeutic relationship with nursing staff meant a lot.

It demonstrated that, while mental health emergencies can be frightening and risky, they are also moments where real human contact can be made, and corners can be turned.

Through showing compassion – not trying to fix mental health problems – but simply listening, nurses can make the world of difference when people need it the most.

Find out more

Beat Eating Disorders


About the author

James Downs @jamesldowns is a mental health campaigner and service user 

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