TRANSCRIPT

Hi Claire, Thank you very much for agreeing to do this conversation with me. Could you give a little introduction to yourself. What it is that you do in your job, your background and where you came from?

Yeah.
So I’m an occupational therapist (OT).
I work in eating disorders and we have a team that we work across community inpatient and day service. We work with all ages from age of 18 plus.

I was originally a social worker and then decided to transition into occupational therapy.
And then when I did a placement within eating disorders in Teesside, I found that I absolutely loved it.
And then eventually the job came up.
When I qualified as an OT in eating disorders in the North East I went for it and got it.
And so here I am.

Oh wow! As a social worker, did you specialize in anything?
I think I don’t know why I thought before, but I wondered had you been dealing with alcoholism?

Yes.
So I worked in children’s services for years and then I worked with Bernardos.

And then I worked as the OT on the ward for eating disorders.
Then I left and I went to alcohol, drug and alcohol teams, and then I came back.
OK.
So you were an OT with Drugs and Alcoholism.
Yes, I was.
OK.

Can you explain a bit about what an OT does?

Yeah.
So it’s just this is one of the questions that we always ask each other.
So I always say something like making that person independent as possible.
So if they’ve had an illness or something that’s happened to them or mental health could be physical health and actually they need to get back to where they were, yeah.
Or change the way that they are because to adapt to the new environment, that’s what’s occupational therapist.
That’s what we do.

Does that vary a lot in your experience now from and well like, yeah, I guess in all of your capacity over the years when like working with alcoholism and then eating distress etcetera, is there a, is there a vast difference?

No, definitely not I think as an occupational therapist, one of the things we stick to is the OT process, OK.
We look at each stage, so we look at the person we look at, the assessment, we look at what comes out of the assessment and how to help that person.
So it’s very person centred.
That’s a very specialized to that person.
So yes, there is areas that we do work on. It might be finances, personal hygiene that kind of stuff could be absolutely it’s it’s endless.
I mean, yeah, it is endless where we would go and that that could be employment, it could be, it could be eating, it could be, yeah, exercise.
It could be anything.
Honestly, the list  just goes on and on.
And so yeah, so we just look at them and we personalize those plans to each person.
So across the board, as occupational therapists, we probably work in very similar ways to get an outcome for that person.
Yeah, but it might be different and depends on what area you’re working in.
Sure.
So if there was a hospital and they wanted to be discharged in home, yeah, probably they’d be assessed for equipment, we’d order the equipment.
Yeah.
And then, yeah, and that would be the end of your intervention.
There’s maybe drug and alcohol.
You would look at trying to move that person on trying to get them to decrease the alcohol decrease the use of substances.
Yeah. Yeah.
Thinking about their environment, thinking about what effects them.
Is it?
Yeah.
The good environment is it not?
Is it?
That’s what’s triggering their use, or even in eating disorders.
Your environment can really impact.
Yeah.
On how you feel

Is there a kind of a standard amount of time that you would spend with each person or you’re looking to and finish with each person in a in a specific time period?

So yeah, we do.
So we can’t just have endless work because we’re just not funded for that.
So we have to look at what that person’s goals are and whether they’ve achieved them.
And actually, if they’re not achieving those goals.
We have to think about where do we go from there?
Is it time to. We often talk about, especially in eating disorders, talk about therapeutic breaks.
Yes, because actually you can have too much intervention and they can come overwhelming.
So yeah, take a step back at that person, then takes the onus on themselves to try and make those changes.
Yes.
Yeah.

And within your role now you say that you do in patient, community and day service. Can you explain what you do in each of each of those and how that that differs.

So as a team we work at the different parts of the service or we call it a pathway.
OK.
So in inpatient it’s a 5 bed ward.
And usually we have to have an OT there specifically for that ward.
OK.
They  would work in and work with those people. So what often happens when they come in, life is just taken over.
Yeah, yeah, yeah.
And then eating disorder has just taken over life.
Yes.
Yeah.
So they are often not ready to work with occupational therapy when the people first come in, because their BMI is really low and actually they’re very starved.
Yeah.
And they’re not functioning properly.
So trying to think about what life will be like through and after an eating disorder, it’s just not on that focus.
Yeah.
So it often is just things like trying to promote rest, restful occupations, rest.
OK,
Trying to use distraction techniques and support with meal times and routines on the world.
So that’s where it kind of basically starts and then you would transition through to maybe discharge into the community, or discharge in terms of day service, or just discharge from services depending on how they’re doing.
Yeah.
And in the day Service, what do you do?
Again, it’s very similar.
Often when people come to the day Service, they usually are a bit more restored health, but that’s not always the case.
OK, sometimes it might be that we’ll do very similar things.
Yeah.
But we’re doing like restful activities.
We have a  weekly plan of what’s on groups and things like that., we have one to one sessions.
So it is just looking at what that is.
We do the assessment and look at what that person needs from that kind of intervention.
That’s how I first met you really through doing one of the sessions that you.
Yeah.
So we did LEAP, didn’t we?
Yes.
Yeah.

And so what is LEAP?

Is it the only session that you run or do you run others?
No, I would join in on others.
LEAP is probably the main one that I’ve run because nobody else wants to run it.
Nobody.
Nobody else has got the passion to reduce exercise and kind of think about.
I think it’s because I was an exercise instructor as well, so I’ve got the knowledge around it all and then I’ve made the program a bit kind of specific to our service, more so than just general.
Yes, I think yeah, everybody just turns to me to do the LEAP program.

Can you talk a bit about what LEAP is?

Yeah.
So there is another word for it.
We call it lowering exercise and activity program

Right
So it’s an 8 week course that looks around the cognitive behavioral therapy of reducing exercise and the difficulties that come with it.
Because that’s so related. It’s integral really in eating distress.
And I think when you did it, I think we would just in the process of changing things around a bit.
So actually now it’s a bit more interactive.
OK.
Yes.

In what way?

In the fact that now we put challenges in every week. so I know I think we were starting to put that new yeah with your with your cohort now we’re kind of we’re start linking it to anxiety.
We’ll start bringing up kind of more sheets and thinking about not just the kind of behavior changes, but why?
Why can’t you change behavior?
Why?
What?
Yes.
Or. Yeah, yeah.
So thinking about this, yeah, anxiety curve, the the you know, the kind of the wheel of change?
Yes, actually.
I did LEAP and I was also working with Fiona on anxieties.
Yeah, bringing those together and that’s what we’ve done and I’ve brought more kind of occupational therapy information into it.
Right.
OK, it’s a bit more OT focused now.
Yeah, it is just doing the CBT model, which I felt was a bit empty.
Yeah.

Do you find that those tend to be as beneficial as one to ones?

I think they are more beneficial.
Yeah.
And we always encourage them.
So every day in the day Service we in fact, even in and on the ward, we will have a group on and it will be about some not just OT led, it would be nurse led Psychology led, dietetics led and it’s always around a different area.
So at the minute we’ve just finished LEAP, we’ve had perfectionist group, we’ve had perfectionist group
We’ve had in the room with bloom, so blooms our medic, so she it does an hour on a specific area in physiology, biology that kind of stuff.
Wow,

It’s been really interesting.
That’s gone down really well.
So is that like explaining how the body works?

Well yeah and the effects. Maybe in one session she looked at potassium levels should then she looked at glucose levels and so and it was really quite interactive.
Yeah.
Well, we just finished.
We just finished a group MANTRA, which is what we use.
Yeah, I did that with.
I did that with Fiona.
Yes, MANTRA is our go to psychological program that we would use across the board in eating disorders.
Yeah, there are others, which the psychologists would do, but we also have their MANTRA where you can most of us can deliver it.
yeah.
Bu t there’s a group MANTRA which again if you get referred to and there’s usually a group of about 10 people, OK.
And it’s really interactive and the feedback from that is so good.
Yeah.
And it, you know, it gets you to open up and gets you to be quite vulnerable.
Yeah.
Yeah.

And and do you find that that build bonds between people and that they encourage each other?

Or do you think sometimes I think eating disorders can be quite distressing and nobody wants to discuss their eating disorder with anybody, even if they know that somebody else in the room has, an eating disorder?
Because even though you know you’re there for a reason, you don’t want to bear your soul.
Yeah, everybody.
Yeah, yeah, yeah.
And it is quite selfish.
Yeah.
Yeah, and very competitive.
I think some of my reluctance has been, will there be things that will trigger me more?
You know, if someone says Ohh I’m you know I’m running 13 miles a day and I’m thinking I’m not and then will that feed it more.  

So, yes it can do and that’s why we don’t always use it. In the community we try and keep people out of Services like that because yeah they’re not the best model of care because you’re being really quite poorly in a quite close environment and there are lots of learned behaviors going on.
Yeah.
We want you to be in a place where you want to be able to recover and you’ve got past that hurdle.
Yeah.
Yeah, you kind of put your blinkers on a little bit and not and not see what else is going on around you.
Yeah, yeah, absolutely.

How have things changed, though over the years?

Because I know when I first became ill 20 or 20 plus years ago and my treatment now I can honestly say is so amazing.
Now I finally feel as though like that’s it’s very holistic treatment, whereas when I was you know 12 when I was first admitted to.
psychiatrist, psychologist and a dietitian, the approach was so different.
And I believe unfortunately that’s some of the way that I was encouraged to behave like the weighing of food by the dietitian and the calorie counting.
Has it actually served me in bad stead for the rest of my life?
Because they’ve now become part of  my obsessive behaviour is and and and Im interested in how what changes you’ve seen look, because I can see it as a patient, but I’m not aware of the whole picture.
Yeah.
And I think we’re constantly changing, but I think there has been over the last, I would say, five to six years massive changes in eating disorder services and how we run them.
I think there’s that we found the link between autism and eating disorders.
I think that’s one of the biggest kind of insights into People’s difficulties.
Yeah, yeah.
ARFID.
When you kind of, it’s not something I think what’s happened is and I think this is kind of general patients have been diagnosed with anorexia when they probably haven’t had anorexia, they’ve probably had ARFID.
And then, because we haven’t had that information, that everything based practice around the link between autism and eating disorders.

Can you explain what ARFID is?

So it’s restricted, it’s Avoidant and restrictive kind of behaviors around food.
So it might be that someone doesn’t like spicy food.
So yeah, whether they like bland food or certain textures, or crunching, kind of that kind of stuff.
And it might be because it linked to autism, but it might not be.
It might just be that someones having that sort of reaction because of maybe an experience of choking, yes, yes and yeah.
So they won’t.
They won’t eat anything that’s solid.
Yeah, incase they choke on it.
So there’s lots of behaviours around kind of foods or disordered eating.
Yeah, sometimes you can just get on with life because actually it doesn’t really make much of a difference.
But actually it can affect you and you know where you do lose lots of weight.
Yeah.
And your BMI is low.
You are vitamin deficient, and that’s because you’re not getting the right amount of food in your body.
But it’s not because of anorexia and that kind of disordered feelings around body image.
Yeah, it’s more about actually, you just can’t tolerate that food and so.

What prompted those changes?

I’m not quite sure, to be honest.
I think what happened was I went off to alcohol team and I came back and they were just like there was this huge thing going on about this.
I mean, I think we thought there was a link and there was lots of kind of information like trickling through.
Yeah, but I remember a lots of practitioners being quite avoidant and saying Nope, it’s like it’s anorexia.
It’s autism and they do not meet in the middle right.
And then I came back after 2 1/2 years in addictions and all of a sudden we’ve got this peace pathway which is around kind of autism and trying to adapt environments to those who not even autism, those who kind of got neurodivergent tendencies.
Yeah, kind of noise.
That kind of.
Yeah.
So that was kind of big on the agenda and like most of our, I would say 50% of our patients are now on the peace pathway.
Wow.
it was you that raised the issue that potentially I could be autistic.
And to me, that has been such a benefit beneficial thing for me, and I wonder how many out there you know, if I if if you hadn’t been doing and sessions with me in my house, you know where you could see me being authentic even if I just met you and it in the daycare centre whether it yeah you know how how much you pick up on but I think we’re quite attuned to it now I think well the discussions that we have when we when we because we always meet regularly to discuss our patient group and we just you know, we often say  has so and so being assessed for autism or and sometimes there is that I think that the one of the reluctance is was when you starved some of the behaviours can kind of exhibit a bit like autism.
So your brains not functioning properly.
You’re not making those links at times.
You know, pacing that kind of stuff.
Yeah.
So yeah, it often can be seen as an eating disorder behavior.
Yeah, I think I think as practitioners, I think especially our team in particular, I think we’re really quite attuned to seeing.
I think it’s amazing.
I really.
Yeah, I really do.
It’s it’s fascinating to see.
And so some patients go through these assessment and don’t come out with this come out as autistic traits which yes which again is beneficial because least you know.
Yeah, yeah.
Actually, that’s not just me.
You know, that’s something that’s a difficulty for me.
Yeah.
Yeah.
And how do you then adapt so and yeah, how?
How do you adapt then?
Once you’ve got a patient with a diagnosis of autism.
So it depends on what they’re kind of difficulties are.
So yeah, they if it was something like have difficulty being in a room with others and the sound of chewing.
Yeah.
Yeah.
So again, probably about 6-7 years ago, that would just been seen as an eating disorder behavior.
Yeah.
So actually, so I mean, I’m mistaphonia is when you kind of when you can’t stand the sound of other people’s making noises and especially chewing.
So what we’ve been encouraging is to put some headphones on.
Yes.
OK, block out that sound.
Yeah, sit in a certain part of the dining room.
So you’re not around, so you’re still in the same area, but you’re not kind of shoved in the middle of the dining room.
Yeah.
Everybody else?
Yeah.
So just adapting that environment, yeah.
And I think for me like some of the things that I found really helpful of being around the sensory things and and also around understanding I I guess a bit more about like just understanding why my brain works the way that that it does and yeah it given a bit of an explanation and you always say to just be kinder to yourself.

it’s almost you comparing yourself to to Joe Bloggs on the street.
But actually you don’t know what they’re going through and how.
And I and I would say I come across a lot of people in my, like, my work in my life and everything.
And you just think, God, we’re all just trying to navigate and life and the world, aren’t we?
You know, not us are perfect.
None of us function at it, you know, 100% all of the time.
We often have difficulties with memory, often having difficulties with kind of, you know, working out A to B.
Yeah.
And yeah, and sometimes we’re just kind of on ourselves and others.
Yeah.
And it is.
It’s just making actually to do.
It’s just hasn’t been a good day.
Yeah.
Tomorrow it might be different.
It might not be, but actually long as our kind of have a path that I wanna keep going on.
Yeah.
And I’ll get there and understanding, like you know, for me like routine and things, its just so important and understanding well you.
That’s just going to be part of who you are.
And so there’s no point.

Why try and change it all?
Yeah.
So yes, some of it you might wanna change or try and change.
Yeah, it might help you a little bit.
Yeah.
You know, some of the rigid behaviours, yeah, are impacting on your life.
Yeah.
Yeah.
So you don’t want them there.
So actually, some of the behaviors you can adapt some of them are a crossover between this.
Yeah, autism or is at an eating disorder.
Yes, it like you say from childhood.
Is it a learned behavior?
Is it something that Services of kind of instilled on that particular time?
Yeah, but that can be changed because that’s actually it’s a learned behavior and that’s not autism.
Yeah.
Yeah, yeah.
I can’t think of things like that.
Some of our behavior this takes so long to change behavior, change.
Change is take like 3 months at least many many attempts.
With that, you know that that connection in the brain, isn’t it?
Yeah.
Have to you have to change it.
Yeah.
And what?
What do you feel?
Are there areas that you feel can still need need to change more or other things?
I think we’re still need the work on the sensory kind of areas.
I think that’s up and coming and I think that’s coming across in eating disorders lots and how we adapt ourselves and our environments and our, I mean we always talk about 5 senses, but there’s actually 8.
Oh, what are the others?

So you’ve got proprioception.
You’ve got vestibular and you’ve got introception.
So what are they?
OK, the proprioception is kind of the impact of how you feel on your body.
So you can imagine like you’re kind of (stepping side to side) and you’re getting that sensory feedback from kind of stepping side to side. For your brain that is allowing you to calm. Soothe.
Yes,

It could be that if you feel like you’ve got like something, you push your head with deep pressure.
Yeah,

To pull that kind of pressure through the head.
So that’s kind of proprioception.

Ah, so like a rhythm
Yeah.
So it can’t be, but could be a push pull.
So imagine you can you know what we have to talk about in exercise is in that feeling that you get.
Yeah, yeah, yeah.
So if you can, you can actually get a similar feeling by pushing against a wall.
So you’re body is receiving that deep pressure, that push.
Yeah.
Yeah, there’s lots around it.
So it’s like, you know, there’s different areas you can think of. When children kind of get overwhelmed they often roll themselves in a ball, you know, and roll around.
So lot of it, it’s around children, but we’re kind of bringing it into adults as well.
OK.
And would, for instance, having a hug or something. Yes.
Yeah.
So yeah, the deep pressure blankets are often used.
Yeah, yeah, yeah.
So that kind of stability, that kind of grounding. We talk about using lap pads and things and putting on your knees, putting on your feet.
Yeah.
Just to ground yourself.
That’s proprioception.
Vestibular is when you kind of balance yourself. So often, you know, we often get a bit imbalanced in life in general, so its about kind of finding ways to kind of stabilize yourself, OK.
You thinking about standing on one leg sometimes?
Yeah.
Yeah, which I guess is like yoga. I find that so helpful.

Yoga is really good for vestibular.
And then introception.
So this is where you find the link between what’s happening in your brain and into your body.
So you can see that you can feel the senses.
You can feel what the kind of feedback your body’s giving you.
Often we don’t understand it.
Oh wow.
And that’s for everyone.

That’s across the board. I think especially in occupational therapy. I mean we when I was at university we didn’t we did about a day on sensory needs.
OK, I think now they’re doing a whole module on it. It’s coming through in Services.

Tell me about the age ranges that you work with and also like the genders. Is it predominantly female that you work with?

It is, but it’s not a predominantly female problem.
Yes, it’s that males don’t come forward as much. We do have males in our service, but they tend to be in our community service more than our day Services.
OK.
It’s usually quite a small ratio of men.
In fact, I think over the last couple of months.
I think we’ve only had one man in.
Males are quite reluctant to coming in because they feel it’s a female dominated area. Yeah.
Yeah.
And I would agree with them.
I think one of the things we did look at before I left the first time  was looking at the environment and it is and all the activities and crafts that we do, it’s all female dominant lead.
Yeah, I do think we’re doing them a bit of an injustice.
When I left we had two males on the ward. that was quite good to have two male perspectives and it was during Covid.
So actually patients were weren’t allowed to leave the ward, so there was quite a lot of stuff going on.
Yeah.
We just tried to adapt to do some more kind of male dominated type stuff

What and how did you do that?
Well, we looked at kind of quizzes that kind of stuff like not just about, you know, Disney and stuff.
But we looked at doing the price is right.
I don’t know if you remember that.
So you just looking many, many years ago.
So we’re looking at kind of just like life skills, but we.
Yeah, it did it in a more of a fun way.
Also, we looked at kind of, you know, this is a washing machine.
How much would you pay for a washing machine?
That kind of stuff.
Yeah.
And you had a stick and you had to put whatever price you thought the washing machine was OK.
It wasn’t just all around.
I don’t know, making flowers. We did baking, which can be a female dominant can area, but actually we’ve got the males to think about what they would bake.
Yeah.
They would come to us with ideas.
Yeah.
We got to do a newspaper, got them to do a newsletter.
Even stuff like the watch on the telly in the evening.
Yeah, telly was kind of more kind of female dominant.
They would say they would like to watch this girly film and and the boys would go “oh no, not that again.”
It was actually made so it’s equal and they got to choose what they watched on the TV that evening.

In terms of the your colleagues, are they predominantly female as well?

Yeah.
And is that a problem?
No, it’s not a problem.
I think we always try when we employ people, we always do look to see if there’s any males and yeah, we’ve just done an interview for an occupational therapist and there was two males.
Yeah, but yeah, it’s it’s quite a female dominated.
I mean, when I went through university, it was there was a full 4 meals out of 50 yard in our class.
Yeah.
Yeah, and wow.
But even nursing, I mean, you look at nursing and even now I think in whole at all of our service, we probably have five males yeah.
1-2 are in admin, two are Nurses.
It is more male dominated on the ward than there is in IDs.
OK, in the community we have one male worker who is the phlebotomist.

And if you had male in-patients, would you try to get male OT’s  to see them?
No, no, no.
OK, I think it’s it’s more about just working with that person.
Yeah.
I think that we try and see gender has not been an issue.
Yeah, yeah, yeah.
Sometimes it is.
Of course it is, but I think it’s because we’re just person centered.
We will do anything to be able to support that person, whether it’s male or female.
Yeah.
And how about the ages?

For 18 to whatever.
So we transition now. We’ve got a good transition pathway from children’s services.
We usually refer a good three months beforehand so we can attend different meetings and we’ve got that smooth transition.
Yeah.
Yeah.
Again, that’s quite new.
That’s OK.
Have to be.
It’s quite new because we we haven’t had a community service.
It’s only maybe a year and a half.
Two years.
The community service, it’s quite a new service.
Oh wow.
Yeah.
So patients would have just got the Community treatment team if they come from children’s services.
That’s right.
It would have been there that they were transferred to.

As opposed to nowhere
There wasn’t anywhere for them to go.
So and only I would say I would say probably about 24 months that we’ve had a community team.
So when patients were in Intensive Day Service (IDS), when they were discharged, they were discharged to either a Community treatment team or just discharged.

Now they can go to.
Now they can go to IDS, yes, so it IDS if if they’re there, they can go to the Community team.
Yeah.
Or they can be discharged or they can go to their community treatment team if they have a worker there.
OK, OK.

And do you do you see  different techniques being more beneficial as age changes?

I think it would depend on where that person come in. I think if we have someone from freed (which is kind of early onset where we we kind of try and catch the eating disorder)
So it’s if it’s an episode in the first kind of three years, OK we what we do is we have a path, we have a freed pathway.
So right, you have a kind of MDT approach to that.
And whats MDT?
Multidisciplinary team.
So, right, so it’s so we always call it an MDT.
So apologies and shortening it, but it was more so.
Basically, you’d have everybody involved as much as possible – psychology, dietetics OT, nursing  and medics.
Yeah.
And you would would have that intensive approach to that point.
Actually, if you catch it early there, there’s now it’s been there’s lots of evidence around the fact that if you catch it early,  the recovery rate is so much higher.
So did you say  three years?
Yeah, right.
OK, so if they so see if someone has had eaten distress or for three years or for two years it is classed as FREED.
OK, OK.
Don’t ask me what FREED stands for because I don’t know!
Yeah.
Yeah, but yeah.
So and then they would have a pathway through to us.
So they have like a certain thing you have to have a given a call within 48 hours, that kind of thing.
Yeah.
Yeah.
So then, so then the intervention would start from there.
Yeah.
And you would hopefully make a difference within that time.
So they wouldn’t come back into Services.
And yeah, is that’s the plan.
And then I guess the behaviors aren’t as embedded and it’s a lot easier to change.
Yeah, it is.
Yeah, yeah, I think you know, then the and the fact that you’ve got all those professionals working towards the goal.
Because often people will come in and they don’t want an eating disorder.
The first time when you’ve experienced it’s yeah, incredibly scary.
Taking over your whole life,

I don’t think anyone asks for it.
No, they you know course and never and never starts out to be like.
It’s a bit of often it’s a bit of control here, or you kind of restrict here because of a certain circumstance or has been a bit of trauma.
There’s usually a trigger.
Sometimes there’s not.
It’s not a conscious thing. I try and explain to people that you know and they’re like, how did you not know? I just did not know.

It’s gradual isn’t it?
So it’s something happens and then something else happens, and then it just gets bigger and bigger, doesn’t it?
Well, yeah, just debilitates you.
Yeah, completely.
And often it germinates on things.
I’ve always been sporty and it just almost likes a ohh yeah, we can see that you’re really good at this.
You’re really, you know, played hockey for my county and stuff.
We’re just gonna take that a little bit and then say that you’re training more say that you have to do you know, and then that became the obsessive, you know, where it wasn’t about enjoyment, per se.
It was about meeting those.
Yeah.
Yeah, you know where?
Where is like in LEAP when we talked about well, When is it a helpful healthy behavior and when does it become an anorexic behaviour that’s telling you to do it. and similarly with food, my mom was a really healthy, conscious cook, and I had a general interest in making sure that I was a healthy person, but then anorexia kind of creeps in and starts going
“Mom, I’m not having X anymore.
Don’t want this anymore?”
And she just thought it was a way of like me, wanting to be healthier.
But actually then it kind of snowballed from there.
It sits on personality traits that it can can manipulate.
So yeah, they perfectionism.
Yeah, rigid rules.
Kind of OCD tendencies or it’s not an OCD, but it’s not like a diagnosis.
But it’s, you know, that particular.
Yeah.
Behaviors that you know, kind of that kind of want.
Everything’s the same.
tidiness, you know?
Yeah.
And and it just makes so much sense with the autism as well.
You know, just it it it’s all become a lot more clear to me now.
So that’s what it does and it you know, so I think that’s where we try and work on people’s behaviors really quite quickly through the FREED.
And I think then then obviously you’ve got people like yourself, Helen, who have come through Services and let you say quite traumatic as a as a young child.
Yeah.
And a lot of the onus would have been yours would have been on your Mom and Dad to get those changes and cause you were the child and they were the parents.
But then soon as you get to 18, that’s it.
You, you, you are now the adult.
Yeah.
And you’re expected to make all the decisions around your ccare.
Yeah, and yeah, that’s that’s what I find quite difficult in the transition now between the Services.
And I think there’s probably lots of work we can still do because, you know you’re 17 and 364 days and Mom and Dad are still making the decisions.
Yeah, next day you’re 18.
You set your care plan.
Yeah.
Do you want it to look like you know what?
Can we do?
Do you want Mom and Dad involved?
No, you know, and then that Mom and Dad are no longer part of your care.
OK.
Yeah.
So let’s lots of things and you know it’s obviously it’s, it’s how the world is and the 18 year an adult and usually 16/17 you’ve got kind of input into your care as well.
But with eating disorders, it’s really quite difficult.
Yeah.

How much do you do with parents?

because that was something that my parents never really had support.
So we have a lot offered to offer the parents and carers, so we have we always involve carers if we can, if we get permission from the patient right, we’ll invite them along to the care reviews.
We will have regular care Contact, should that be allowed.
Post 18
So yeah, if we have consent we can share whatever the patient wants with that person who is seen as their carer, OK, we have a course called collaborative skills.
Which is a usually a 12 week course which is run each evening at each once a week each evening and we get parents to come along.
or carers or anybody who wants to come along too and do it in module around kind of anorexia and thinking about how to care for that person.
What to say what not to say?
Yeah.
Yeah, yeah, yeah.
How can you support and that could be friends that could be.
Yeah, if you’re, if you’re happy for them to come along.
OK, long to that.
Yeah, that’s a really good course to come along to.
We have a carers champions that will link in and try and do kind of charity events and things like that?
Yeah, yeah.
Linking with carers groups.
Oh wow, that’s amazing.
There is lots going on.
That was something that was really under you provided for.
Don’t get me wrong, I still think there’s lots more we can do.
I think probably as Services we don’t put as much emphasis on carers as we probably should, right?
Yeah, Carer, burnout.
And yeah, you know, and because especially if you’re in the community on day Service, we don’t see carers that often.
Yeah.
So it’s more, you know, you’re just gonna have maybe have regular contact or if you haven’t had consent, you don’t know what’s going on.
Yeah.

And I’m very aware at the moment of like the kind of end of life decisions being in the in the news around eating disorders and what’s your opinion?

To be honest, I don’t know much about it, so I wouldn’t be able to comment too much.
It’s just more about what we experience in our service.
Yeah.
And you know, I think I haven’t personally come across a lot of end of life decisions in our eating disorder Services?
probably more in addictions,
but that wasn’t really end of life decisions.
It was just the they passed away.
You know, one day they were, actually, they weren’t, but yeah.
So I think I think we just try and treat the person as much as possible.
Until that point comes.
Until one of the medics would say. Right, there’s not much more we can do.
But it wouldn’t come from our medics. It would come from obviously somewhere, in the acute hospital.

And what about some of the terminology that you use in terms of like what do you understand recovery to mean and do you think that someone with an eating disorder or eating distress can be fully recovered?

I 100% agree thay someone with eating disorder can be fully recovered.
Yeah, I think it’s a long journey.
Yeah, I think depends on where you starting in your journey.
Yeah.
So I think somebody who’s come through FREED pathway, it’s obviously gonna be shorter.
Yes, if if they’re, if they’re kind of willing to put themselves forward and kind of try and do it with our team.
Yeah, I think it’s a bit harder.
So someone who’s kind of had anorexia or an eating disorder for a long time.
Yeah, but I do believe that they can still recover.
I think recovery is just personal.
Yeah, I think someone could get to a BMI of 17, you know.
Yes, it’s still underweight, but actually you can still have a life.
Yeah.
Yeah, still do what they need to do.
Yeah, and often that can be the case.
You know, can they function?
Can they work?
Can they manage a meal plan?
Can they still study?

is their Health, OK, are their blood’s OK?
Yeah, that, that to them could be recovery.
You may never have 100% healthy relationship with food.
Yeah.
Yeah, may always have that little niggle in the back of the head about how they can’t have this and how they won’t do that
Yeah, but I think, yeah, if that’s recovery for them, that’s recovery.
So would you have a definition of what recovery is?
No, because I think again, it’s personal, I think, yeah, obviously recovery textbook definition would be recovery would be to be able to be a BMI of 20 to 25 and a healthy, you know yeah.
And it when it comes to an eating disorder.
Yeah.
And not having those kind of negative thought patterns.
Not having that anorexic thought process, you know, not questioning the other things or other professionals and going out having a life.
Yeah.
And able to eat a meal with a friend.
Not think about what you’re spending, not thinking about what you’re having.
Where you’re going.
Yeah.
Yeah, yeah, yeah.
Not over thinking about everything. that could possibly be recovery for one person, not for another.

I started using the term eating distress as opposed to eating disorder. Is that something that you’ve seen in Services?

I think it would depend on where you are and what Service you’re in.
So OK,

I think eating distress northeast (EDNE) use it because they deal with lots of eating disorders.
So they don’t just deal with anorexia or bulimia like our team do.
They will also deal with ARFID and restricted type stuff or trauma.
Yeah.
Yeah, even things like comfort eating and excessive eating?
Yes, they do.
They deal with a lot more than what we do as a service.
Yeah, I think in our terminology, we still call it any disorder because that’s what it is.
OK.
Yeah, it is stressful and it is distressing.
However, it’s disordered and I think that’s probably where our terminology still sits because even within medical journals it will still be described as an eating disorder.
Yeah.
And is that with the assumption that is biological or what makes it a disorder?
Because actually it effects your brain is functioning and your brain is not functioning fully to be able to make those informed decisions.
Yeah, yeah, yes.
It works like anything. Take, for example a personality disorder.
And I know there’s lots of discussions around changing the word from disorder, you know, to alternatives.
And again, and I think it’s probably is gonna come at some point because these things do change.
Yeah.
You know, that’s interesting to think.
Where that came from.
And yeah, I think it it’s these things take out a long time to in bed and Services and and how we kind of react to things.
Yeah.
Yeah, but a lot of it is medicalized.
That’s what we go with.
Umm.
Medical model.

What first made you want to be an OT, and specifically within eating distress?

I think I just fancied a change in life.
I didn’t know.
I’d come to a bit of a crossroads and I had a bit of a kind of traumatic event and I thought, what do I wanna do?
Do I wanna plot on with life and just be miserable and actually hate going to work every day, or do I bite the bullet, become really skint, become a student again?
And then so that’s what I did.
Yeah, it was.
It wasn’t easy.
Yeah, it really wasn’t easy.
As a 40 odd year old woman doing a degree again, it was.
Wow,

It was hard, but it was worth it in the end.

And do you enjoy what you do?

I do.
I absolutely love it.
Yeah, I get out of bed in the morning and I want to go to work.
That’s amazing, isn’t it?
It’s really good.

What are the factors that keep you loving it because we all hear about how the NHS is underfunded and you’re all not getting high enough wages etc. So what are the factors that make up for this?

You don’ t go into the NHS to earn money.
Not decent money, you know. Anyone who tells you that it is, is talking rubbish!
You know the pay scales when you go in, you know, you can only get to a certain band in certain areas.
So actually it’s not about the money.
I think it has to be something like a vocation.
Yeah.
That you really want to do it?
Yeah.
You know, if you want, if you want the money, you need to go elsewhere.
I think I for me it’s definitely about being able to support people living, yeah.
I’ve got quite a few nurses in my family, and I never wanted to do nursing. Nursing has never been for me.
Yeah, I think what I see the difference between as a nurse is they do things for people.
Yeah, because that’s kind of their job.
Whereas for OT’s, we try and make people as independent as possible and get them to think about what they can do, give them some ideas, but let them go with it.
Yeah.
I think for me it’s nice to plant that little seed, sit back and watch and see how it kind of blossoms?
Yeah.
Think that’s?
That’s what I that’s what I love.
And even if it’s tiny, even if it’s a small change, it’s just amazing.
Yeah, to see.
And you can do that with everybody.
I mean, don’t get me wrong, doesn’t always work.
And, you know, people aren’t always ready to work, and you can so see how these people can blossom, but they don’t, at that precise moment in time because actually, life not like that ,is it.
It’s not textbook.
No
So I think that’s why I enjoy my job so much and it’s so varied.

You mentioned before that you are an exercise teacher.
How has your involvement in the eating disorder Service changed your way of looking at yourself and your eating patterns and you’re relationship with food at all?

No, I wouldn’t say so.
But I would say it’s definitely there.
As you can imagine, working in the fitness industry industry and I suppose the need for perfectionism, yeah.
However, I think what what I have noticed is that I don’t take it seriously.
Yeah.
And what I tend to work with is
What I find is that people in my classes are all different shapes and sizes, and are there for a reason.
Yeah, those who are really kind of into their fitness are generally in the gym.
Yes, OK.
Does that make sense?
And that generally they’re doing most things kind of individually.
Yeah, and are working on themselves.
People come into group fitness because it’s just fun.
It’s fun.
Yeah.
And I think yes, I do have lots of conversations about people always come up to me about food and exercise and what can I do to lose weight here and what can I do to lose weight there and I say I’m not giving you advice.
It’s not my job to do that.
I’m here to have a good, fun and exercise with you.
I do give advice on, you know, not injuring yourself, that kind of stuff. And I don’t.
ever kind of bring my I don’t ever bring my work into it.
I suppose what I do do is bring my exercise into my OT work in a good way and not a negative way.
It’s, I would say there’s probably still a big drive on telling patients that they can’t exercise and I know that and we know that’s really quite difficult not to.
Yeah, just thinking about how can you reduce, yeah, to a safe level of exercise.

And do the exercise that fulfils you in ways that so you know those group activities or if you know it’s providing something else other than calorie burning.
Yeah, it has a role.
That’s exactly, yeah.
Yeah.
And what?
What I’ll say in my classes is “you are here for you.”
You’re not here for me, so I might tell you to go harder, but that’s just because that’s just what we do as exercise instructor doesn’t mean you have to do it.
Yeah.
You choose whichever weight you have.
You choose whatever you do.
You can stop and stand still.
Any point you know, it’s your work out.
Don’t think about whatever people are around you.
Yeah, but actually you get that group environment which spurs you on a little bit, yeah, to achieve your own personal goals.
Yeah, not the goals of the people next to you.
And that’s why I think that’s what I see in eating disorders as well.
It’s about not comparing yourself to those around you.
It’s about actually having a life of your own.
Yeah.
What you want to achieve.

With the group activities in IDS and things.

Have you seen a role that doing creative things can have in people’s recovery?

Definitely.
So one of the big things that we see in eating disorders is perfectionism.
So whatever you do is never good enough. I haven’t done this for a long time, but if do a craft activity, they’ll always be comparing around the table.
That’s not very good.
They haven’t done that.
That’s not the right colour.
That’s not this.
And then, yeah, So what I encourage is just do it.
Yeah, it just enjoy your piece of work.
Actually, it may be totally different.
The person next to you, who?
Who said it has to be perfect?
Yeah.
What are you gonna put it in the gallery?
Who’s it perfect for?
Yeah.
So are things that so for instance, I can imagine like a still life you know, and then there’s some comparison because ohh yeah, yours looks most like a daffodil or whatever. Are there like creative activities that are tailored so that it’s not so that they might be doing more abstract things than where?
OK, then you know, you think, right I’m gonna design this activity so that there’s the least amount of doing something right or wrong.
Yes, all the time.
I did that when I worked on the ward quite a bit, I don’t do it as much as I do because I haven’t had time to do it.
You know where I am now, but yes, I used to go.
OK, this is what we’re doing today.
So one of the things I would do is I would do a treasure map and a treasure map would be your treasure map and you put on whatever your goals are or whatever you see your life as, where you see yourself now.
And I would put a whole lot of magazines in the middle.
Yeah.
Or some colours or whatever, and go off you go.
Yeah, yeah, yeah.
And you would see blank faces for quite a big period of time.
Some people walk off.
Wouldn’t even engage in it.
Yeah, because it it’s that fear of just not getting it right.
Fear of putting things on a piece of paper. Just.
Yeah.
And I would just sit there and I’d glue things on about a football team that I like.
And yeah.
Yeah, and stuff like that.
But yeah, so it was really difficult and people had to keep coming back to it at times.
Yes.
So it’s kind of it’s it sounds cruel at times, doesn’t it, about doing that, but actually it’s getting people to think about who they are.
Yeah.
And I find that if I’m ever doing workshops and things. Even when I’m doing things at uni, you know people are still like really reluctant to do something that they might fail like or in their eyes fail.
But I’m always like everyone can draw.
Everyone has it within them.
It’s just might not be a  style of drawing that you are have been programmed to think is the right way of doing something.
But there is no right way.
No, it’s not.
I remember doing a task at Uni when I was in the first year and at the time I couldn’t work out why they were making us do this task.
So that you’d have like a Picasso or something like that.
And then you had to split this Picasso up to three bits.
Then you have to draw one bit, your colleague had to draw another bit and then you have to put them back together to see what it actually looked like and see whether you could match up and stuff like that.
And it was really interesting and it was only probably a good year later than I reflected on that and thought, yeah, now I understand now.
Yeah, yeah, yeah.
And so do it.

Is there a place within treatment where art therapy is ever used?

Yeah.
So we don’t have an art therapist, but art therapy is used within recovery services and within eating disorder Services across the country. It’s just where they are funded.
We do have, I’m not sure what she is classed as, but she does a lot of stuff around movement.
She’s quite new to our team.
She’s only been around probably for about a year.
And that’s quite good.
She’ll think about kind of a subject area and plan her session on that, and it’s usually about the movements, the kind of thoughts, the feelings around that.

That’s fantastic and that works really well.
Actually that’s been one of the most popular groups we’ve had.

If you’ve had like particularly hard challenging days with people, how do you look after yourself?

I think for me, I’ve got a really good support network and like friends. Family.
Exercise.
Yeah, I’ll go to teach a class after I’ve had a hard day at work. That’s great for me.

And sometimes I’m not even participating. Sometimes I’m just walking around the room and supporting people, so it’s not like, yeah, it’s not because I’m doing the exercise, it’s because I’m actually in a different environment.
Sure.

Just slob out and watch a bit of telly. Put my feet up and also go to bed early because I don’t always get to go to bed early.
I might not go to sleep, but yeah, I’m lying in my bed. I’m watching my iPad.

Sometimes it’s hard, sometimes it takes me a while to peel off the ceiling depends on what happened that day.
To be honest it’s not usually patients.

OK, it’s not really that because I don’t find that particularly difficult.
It can be frustrating, but it’s not frustrating for me.
It’s more just because of what’s happening with the patient.
Yeah, yeah, yeah.
It’s it’s upsetting at times because it’s, you know.
You see how unwell people are.
I do ruminate, or you know doesn’t my head does not always clear at night.
Sometimes think about that person in the evening.
Yeah, you can’t not; it’s human nature.

Do you have support then within the NHS? Do you have a supervisor?

Yes.
So we have supervision, monthly supervision.
We have psychological supervisions we have clinical management supervisions we have the psychologists who give us monthly supervisions. As a team.
Or I’ve got really good bunch of colleagues that you’ve always got somebody to speak to.

Do you find that a lot of what you do now and when you were working with addicts and are there a lot of similarities?

Yeah, it was funny actually cause one of the medics just asked me that question today.

Yes, there is it in that.
Obviously it’s not classed as an addiction,  but it’s it’s a behavior that you know, that takes so much change in that environment.
I mentioned before that the environment having to change your environment.
So if you talk about an addict, alcohol or any substances to be able to refrain from that substance, you have to take yourself way out of that whole environment and not the people around you.
Probably your house is a trigger.
Yeah, probably.
Yeah, yeah.
Living as a trigger?
So to be able to fully get away from that, you have to literally move yourself.
And that’s part of the reason why people go into hospital, isn’t it?
To remove yourself from that situation.
Yeah, life still there when you get out?
Yeah.
So it’s yeah, there’s lots of similarities.
There’s lots of similarities around kind of the thought processes that cycle of change, you know.

I think also about like the work that’s involved, you know you you hear people like I’m  a recovered alcoholic or whatever.
But actually like there’s so much work to maintain you in that in that position, you know to to be able to then go to a pub and say no to a drink.
Yeah, it’s not.
It’s not that suddenly that’s easy.
It’s just that you’ve kind of taught yourselves

You’ve been through a process, haven’t you?
Yeah, you’d be able to meet to this links those behavioral changes to know that actually to have that alcohol will be detrimental because we can’t just have one.
Yes, and to spiral and actually you’ll go back into that kind of despair again where you can’t get out and you’ve gotta start again.
And physically you feel unwell?
Yeah, well, yeah.
And I see that a lot with like you know, even if someone’s met their BMI or whatever, and is actually, you know, classed as now recovered or healthy. Their relationship with food and they’re in order to maintain that we requires so much it’s so much work to keep that.

It’s almost you’ve got something in the back of your head possibly. There’s also part that is also worried about what if I go down, and actually I think eventually that will kind of disappear a little bit.
Because the more it’s not happening, you can get confident in yourself that actually it’s going to be alright.
You know things aren’t.
Yes, we all have low mood.
We all feel a bit rubbish about ourselves.
Yeah, but the difference between having low mood and having depression is the length of the episode, isn’t it?
So you could feel crappy for a couple of days, and then you wake up one morning and think, well I’m alright today.
But depression is when it keeps going and keep going.
Keep going, which is like an eating disorder, isn’t it?
Each day is the same?
Yeah, when you start making those changes and start to feel a bit better, that’s when the behavior change starts to come.
Yeah.
And that’s when actually it’s feels a bit easier.
So you find one challenge, you get over it, you find another challenge, and you can do and what anorexia will do to you, it will bring another challenge in for you will bring another one in.
So you just thought right, I’ve conquered that.
I’m alright and yeah, something else have triggered and then you’ll think now Ive got another one I got to get over.

Within film, television, books, within culture, do you think addiction, eating disorders, Mental illness are depicted accurately? 

It depends on what you watch really. I think it’s getting there.

I think you see some of it, which is a bit more realistic than others.
I think you still get the ridiculous programs that you know all of a sudden you’ve recovered from an addiction within a couple of days, you know, and also you don’t really get the full true picture of how that person’s feeling and actually the full pattern and where has that addiction come from.
Nobody gets addicted to anything, just for the sake of it, do they?
You know, I don’t go out one day think I’m gonna take heroin cause I fancy being addicted.
So I think you have to be careful in what we see on TV.
I think again, there’s so many channels out there, isn’t there?
So many kind of places that make these ridiculous things.
Yeah.
Even Instagram and Tick Tock is so unregulated, isn’t it?
Yeah.
Toxic, isn’t it?
Yeah.

Has the use of social media become more pronounced in people over the last few years, you know, meant  that, services are now having to address more because they see the negative influence of social media or perhaps the positive influence?

Yeah, I think it’s probably a bit of both.
I think it’s been, it’s been around for a while and I think it has an impact anywhere, but I think trends change, don’t they?
So I think we often look out for a trend and think, oh, God, what’s coming next, you know?
Yeah.

and think how is that going to affect the young people coming through?
But I think as an older generation it’s trying to understand what is out there.
Yeah.
What are young people looking at now and what’s available to them?
And it does that have an impact on mental health.
And I think one of the biggest things that has an impact on mental health is these influencers who or anybody who promote these fabulous lifestyles.
Yeah.
And actually there isn’t such thing as a fabulous lifestyle like that, is it?
It’s all kind of behind the scenes.
It’s literally a 5 minute video or whatever, and it actually normal life.
Yeah.
And I think these kids or even my own 17year old son has this belief of this is what everybody else’s life like.
Yeah,

He talks about wanting to be a footballer or a YouTuber because he wants the money.
Yeah, it’s really hard for me to get my head around what life is like for them.
Yes.
Yeah.
Yeah, yeah.
Don’t fully understand because I don’t watch them.
No, and if I do go on TicTock, I usually get a bit bored after about 5 minutes because I only ever watch the jokes.
You know, and I think that doesn’t bother me.
Yeah, but it does the young people.

So is, you know, if you’re on the ward and things are those things banned?

no,
Obviously, if it was become quite detrimental.
Yeah, but I think the trend at the moment is to use weights, you know, so that often young girls are encouraged to be more kind of muscular.
OK, right.
Now it seems like that’s kind of coming through in social media and stuff.
and not to have that thin frame anymore.
Yeah.
And I think it adjusts as the trends change all the time and it does impact people I think.
But I think lifestyle is the biggest thing.
It’s almost well.
Why can’t I look like that?
Why can’t I be like that?
Why don’t I have the long blonde hair like that person?
Yeah, it’s it’s normally the image, isn’t it?
That they portray.

umm.

In an ideal world, what would you put in place to lessen the rise of eating disorders?

That’s the billion dollar question! I think we need more funding for a start.
But you know there isn’t an everlasting pot of money. Is there? I think somebody said to me the other day, I can’t remember who it was but they said that we need more staff.
And I said, if you need more staff, you get more staff, you have more patients.
Yeah, you’re wouldn’t give you more staff and not a higher caseload.
It doesn’t work like that.
So yeah, there’s always kind of commissioning, isn’t there these days.
So I think definitely more money, but being able to spend more time with patients, maybe a more intensive treatment, yeah.
Probably just thinking outside the box. So we do have individualized treatments.
But you know, there’s only so much you can do, with resources you’ve got.
Yeah.
So thinking about what can you do and that’s not just kind of specific to that area.
And I think in each area, eating disorder services are run very differently.
So yeah, you know, it’s always interesting when you hear somebody else’s eating disorder Service, how that works.
Yeah.
And the difference in care in Scotland as opposed to England or what have you.
Yeah.
And I think there’s there’s probably so much more you could do.
Yeah.
Yeah. And how?
How about in terms of getting the awareness out there of what it is.
I think it’s probably getting better.
I think BEAT are really good at doing that.
Yeah.
I think as our service personally were not because people are referred to us, yeah, there’s no need for us to kind of advertise who we are.
Yeah.
Because in our commissioning pathways you can only be referred in by a Community treatment team.
Yeah.
So even your GP has to go through community treatment team that gets through to us.
Yeah.
Yeah.
So I think we don’t need to promote, I think the promotion of eating disorders needs to be kind of more prevalent in, especially in schools.
But also I don’t really wanna be talking about it too early in schools if that makes sense.
As in, you don’t want to young people to focus. I just want them to have lives?
Yes, just eat food.
Just play out.
Do this.
Do that.
Maybe this morning I was talking about children kind of being classed as overweight when they’re having their weight done in nursery. Actually I just look at the children.
and think, they’re just young kids?
Yeah.
So you know, and I get government agenda and I get what’s going on.
But actually is it helpful?
Yeah.
Yeah.
In the in the bigger picture, I don’t know about you, but when I was at school we just went to school.
Absolutely.
Up until about secondary school when things probably slightly changed when the emphasis on you know how you looked and that kind of stuff.
But in primary school, we just went to school.
Yeah, we played in our gym knickers.
We didn’t even think anything about it.

And that innocence is almost it’s part of being a kid, isn’t it

Two and three and four and five year olds talk about feeling depressed, feeling anxious, feeling overwhelmed.
Yeah.
And I don’t think I even knew what those words meant as a child.
And I think that that’s how life and society is changing, isn’t it?
And I think it’s for me, it’s about trying to adapt to that and understand it a bit more.
Yeah, but yeah, yeah, I find it quite upsetting that the children can’t be children.
Umm, but I’m aware.
I’m also aware that we need to be aware of how these things can kind of start early on.
But I think that’s probably a bit of that round social media round government guidelines around being weighed that early. Yes.
Yeah.
Yeah.
And I think that like COVID kind of emphasized  the importance of getting their language right and things.
And and maybe it maybe it’s about being a bit less focused on like disorders and things like that, but just giving people the awareness when they’re young and not rules.
Yeah.
I mean, I think there’s such a emphasis on mental health now, which is good.
Yeah, it’s really supportive and there’s so many services out there, I think you were talking about your GP Services surgery before.
I mean, they’ve got so many Services within GP surgeries.
Now that primary care are almost like little mini hospitals.
They yeah, they have.
Like you know, the you like mental health services psychology.
And they sometimes have OT’s in surgeries. Now.
Yeah, have physiotherapists, you know?
Yeah.
You see a welfare.
They have lots of. Yeah.
Social prescribing?
So they have so much going on.
And that’s to try and stop everything going into the acute.
Yeah.
And then, yeah, you care, just start thinking about that kind of specialized services.
Yeah, yeah, yeah.
And then obviously weve got loads of charities and things that are funded to support anybody who needs to go into that third sector type care.
Yeah, but yeah, it’s I think that that’s the emphasis now is to try and treat that person, within your GP and make it a holistic approach?
Yeah.
And I think from this from this conversation, certainly what I’ve got is that you keep going back to, well, we’re person centered and actually you know, there’s links between, you know, addiction and all of these things.
But at the end of the day, how I approach and how I do my job is very much related to the person that I’m dealing with, and I think that’s really beneficial for everyone and  I’m really pleased that that has been or is the way that yeah that Services go.

I think I would probably across the board in CNTW but I think in our in our service in particular, yeah we ‘re all extremely person centered and everybody that we work with is so very different.
Yeah, yes, you’ve got. You’ve got an eating disorder.
Yeah, that’s probably the only thing you have in common.
Yeah. Yeah, yeah.
Yes, you might like similar music and things like that, you know like.
But no, that you have your own personal difficulties with you disorder.
Yeah, and how and your plan is personal to you.
Yeah.
And yeah, yeah.
Yeah.
So but maybe got swapped.
I’ve got you to do something.
I was asking another patient to do that would be no good for you.
You know, it wouldn’t. Wouldn’t work.
Yeah.
Well, thank you, Claire.
That’s been so insightful and really, yeah, really helpful.
And and kind of encouraging as well that you know there are changes constantly being made and yeah, yeah.
Is there anything that you want to add or more?
I think I have.
I think we’ve covered loads somewhere.
I have, I think we could probably still keep going on.
Totally, totally.
But yeah, thank you so much.
Really appreciate it.
Very welcome.