School staff experiences of eating disorders - academic journal article

We don’t know how to help: an online survey ofschool staff

Pooky Knightsmith, Janet Treasure & Ulrike Schmidt

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, De Crepsigny Park, London, SE5 8AF,UK. E-mail: [email protected]

Background: Eating disorders (ED) have a peak rate of onset in school-aged children. Little is known aboutteachers’ experiences of ED. Method: A total of 826 school staff completed an online questionnaire exploringtheir Eating Disorder experiences. Responses were analysed using content analysis principles. Results: 74 percent of respondents’ schools had received no training on ED, 40% did not know how to follow uppupils’ Eating Disorder concerns and 89% of respondents felt uncomfortable teaching pupils about ED.Conclusions: School staff feel ill-equipped to support ED. Training in the recognition, support and teaching ofEDwould be welcomed and could improve outcomes for young people.

Key Practitioner Message

• Eating disorders have a peak onset in school-aged children

• School staff can play an important role in recognising and supporting children and adolescents with eatingdisorders

• School staff currently feel unable to adequately support children and adolescents with eating disorders.Training is not widely available and most schools have no policies or procedures in place for managing eatingdisorders

• Reintegration of students who have been absent from school receiving eating disorder treatment poses a par-ticular challenge. Schools would welcome tailored support to ease the transition

Keywords: Anorexia; bulimia; binge eating disorder; eating disorders; teacher; school

Introduction

Mental health issues are highly prevalent amongst ado-lescents with between 10% and 20% suffering from adiagnosable mental disorder (Kataoka, Zhang, & Wells,2002; Green, McGinnity, Meltzer, Ford, & Goodman,2005).

It is well documented that children with mentalhealth problems do less well in terms of academic andsocial development with lasting implications for laterlife (Farrington, Healey, & Knapp, 2004; Colman et al.,2009). Numerous education policy initiatives in theUnited Kingdom have sought to implement anenhanced role for schools in the mental health andwell-being of their pupils, with a particular emphasison the prevention of mental health difficulties. Thisincludes ‘Every Child Matters’ (Department for Educa-tion and Skills, 2003), ‘National Healthy Schools’(Department for Education and Employment, 1999)‘Social and Emotional Aspects of Learning’ (Depart-ment for Children, Schools and Families, 2007) andthe ‘Targeted Mental Health in Schools Project’(Department for Children, Schools and Families,2008). Of all of the mental disorders arising in adoles-cence, eating disorders (ED) have the highest rate ofmorbidity and mortality due to complications of thedisorder and completed suicide (Rome et al., 2003).

The peak onset of Eating Disorders is between the agesof 10 and 19 (Currin, Schmidt, Treasure, & &Jick,2005) and recent statistics show a dramatic increasein hospital admissions for patients with ED of this agein England (Health and Social Care Information Cen-tre, 2012).

When ED are treated early, outcomes can be very posi-tive with a good chance of full recovery (Treasure, Clau-dino, & Zucker, 2010). Therefore, Eating Disorderprevention and early intervention are key to ensuringsuccessful long-term outcomes and school staff are inan excellent position to facilitate this process (McVey,Lieberman, Voorberg, Wardrope, & Blackmore, 2003;Shaw, Stice, & Becker, 2009), provided they have theappropriate knowledge and understanding (Knight-smith, Sharpe, Breen, Treasure, & Schmidt, in press).

Unfortunately, training on Eating Disorders is oftenlimited (Neumark-Sztainer, Story, & Coller, 1999; Piran,2004) and ED and mental health, in general, are oftennot readily talked about in schools and seeking supportcan have a significant stigma attached (Bowers, Manion,Papadopoulos, & Gauvreau, 2012).

The current study aimed to gain an understanding ofUK school staff experiences of ED in school, includingaccess to training to assess whether they are adequatelyequipped to support children at risk of, or currently suf-fering from, disordered eating. We also aimed to generate

© 2013 The Authors. Child and Adolescent Mental Health © 2013 Association for Child and Adolescent Mental Health.Published by John Wiley & Sons Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA

Child and Adolescent Mental Health Volume **, No. *, 2013, pp. **–** doi:10.1111/camh.12039

recommendations from school staff about how theycould be best supported in helping young people withED.

Methods

DesignThe study comprised an anonymous online questionnaireaimed at school staff in UK schools. A convenience sample of1250 school staff were invited to participate.

Institutional review board approval and informedconsent proceduresEthical approval was obtained from King’s College LondonResearch Ethics Committee (Ref PNM/09/10-110). Once theyhad logged into the questionnaire, participants were providedwith detailed information about the study and were given theopportunity to contact the research team about the project. Itwas made clear to participants that by completing the survey,they were giving their consent to participate in the study.

Survey contentThe survey explored school staff experiences of ED, includingaccess to training and support. It also asked for recommenda-tions about how they could best be supported in helping youngpeople with ED. The items included in the questionnaire aresummarised in Tables 1 and 2.

Development and pretestingThe online survey was developed following consultation withteachers and pupils. Face validity was judged by a panel ofschool staff who met as a focus group to discuss the structureand content of items in the survey. The panel provided usefulcomments for wording and restructuring of items to improvethe ease of understanding and completion, but reported notechnical difficulties or problems with comprehension. Thepanel agreed that the survey had adequate content validity inthat it contained a representative sample of items relevant tostaff experiences of ED in school. 26 teachers completed the

survey 10 days apart with kappa coefficients ranging from 0.78to 0.88 for the closed questions outlined in Table 2.

Recruitment processA database of school staff email addresses was obtained from ateacher training provider. All staff on the list had previouslyexpressed interest in mental health training and came from avariety of primary, secondary and special schools from through-out the United Kingdom.

Staff were eligible for inclusion if they were currentlyemployed, or on a placement, with a UK mainstream or privateschool of any type.

Survey administrationThe study consisted of an anonymous self-report online ques-tionnaire, which took between 10 and 30 min to complete. Com-pletion of the questionnaires was voluntary and no incentiveswere offered for participation. The data were collected betweenSeptember 2010 and April 2011.

The questionnaire was hosted on a survey website, whichwas not password protected. The questionnaires consisted of acover page containing the information sheet and 19 question-naire items, each of which appeared on a screen alone. Onlyquestions relating to the participant’s school type and role werecompulsory. There was no randomisation of items. There wasadaptive questioning such that, based on their previousanswers, only relevant questions were presented. Participantswere given the opportunity to review and amend their answersprior to submitting their responses.

Response rates1250 school staff were invited to participate and, of these, 826(66%) chose to complete the questionnaire.

Preventing multiple entries from the same individu-alsMultiple responses from the same IP address (same computer)were prohibited to prevent multiple entries from the same indi-viduals.

Table 1. Summary of Staff Responses to Eating Disorders (ED) Experience Survey – Closed Questions

Does your school have an Eating Disorderpolicy? (774 respondents)

No Yes – part ofanother policy

Unsure Yes – specific policy

320 (41%) 208 (27%) 205 (26%) 41 (5%)Are Eating Disorder policies effective?(519 respondents)

Effective Ineffective Very effective Very ineffective317 (61%) 148 (29%) 42 (8%) 12 (2%)

Has your school offered ED training?(791 respondents)

No Yes583 (74%) 208 (26%)

Who attended the training? (147 respondents) 3 of fewerstaff members

Whole staff All pastoral staff All middle andsenior managers

82 (56%) 43 (29%) 19 (13%) 3 (2%)Training delivery method (161 respondents) Seminar Lecture Writtenmaterials

107 (66%) 37 (23%) 17 (11%)If you have not received any training, do you thinkyou would find training useful?(346 respondents)

Very useful Quite useful Not very useful Not at all useful160 (46%) 156 (45%) 30 (9%) 0 (0%)

Are you aware of any current or past cases of EatingDisorders in your school? (530 respondents)

Yes, directly involved Yes, not involved No266 (50%) 181 (34%) 83 (16%)

if a student is concerned a friendmay have an ED Talk to anymember of staff

Never beendiscussed

Concerns goto specificstaff member

Use anonymousservice (e.g. SMS)

364 (47%) 287 (37%) 112 (14%) 18 (2%)Would you feel comfortable teaching studentsabout Eating Disorders? (785 respondents)

Very uncomfortable Uncomfortable Comfortable Very comfortable419 (54%) 273 (35%) 84 (11%) 9 (1%)

Has your school reintegrated students followingabsence due to ED? (487 respondents)

Yes No329 (68%) 158 (32%)

Did staff/students receive any advice on how tosupport returning students? (317 respondents)

Yes No240 (76%) 77 (24%)

All questions were optional. When not all participants recorded a response to a question, percentages were calculated according to thenumber of respondents to the specific question.

© 2013 The Authors. Child and Adolescent Mental Health © 2013 Association for Child and Adolescent Mental Health.

2 Pooky Knightsmith, Janet Treasure, & Ulrike Schmidt Child Adolesc Ment Health 2013; *(*): **–**

AnalysisThe questionnaire generated quantitative and qualitative data.The quantitative data were responses to multiple questions.These data were summed and the raw number of responses cal-culated for each item was recorded as well as a percentage. Allquestions were optional. When not all participants recorded aresponse to a question, the percentages were calculated accord-ing to the number of respondents to the specific question.

Much of the data generated were in the form of free text.These data were analysed using content analysis – a process bywhich the ‘many words of texts are classified into much fewercategories’ enabling analysis, examination and verification(Weber, 1990; Flick, 1998; Mayring, 2004).

A categorisation system was developed by analysingresponses and classifying them into categories with care beingtaken to ensure that the coding system was comprehensivewhilst avoiding overlapping of categories. A second researcherindependently applied the categories, blind to the originalresearcher’s decisions. An interrater reliability of 89% wasachieved [(1808 of 2032 decisions were identical –Kappa = 0.471 (p < .001)].

Results

Demographic informationThe 826 participants completed our questionnaire in avariety of roles and phases. They comprised members of

school staff from 548 individual schools and colleges.Participants came from secondary (n = 531), primary(n = 116), special schools (n = 102) and further educa-tion colleges (n = 77).

The majority of participants were teachers [35%(n = 286)] or middle leaders [24% (n = 196)]. 17 per cent(n = 137) of respondents were senior leaders, 15%(n = 127) were pastoral leaders and 10% (n = 80) weresupport staff including school nurses and teachingassistants.

84 per cent (n = 447/530) of respondents were awareof current or past cases of ED in their schools and 50%(266/530) had been directly involved with cases.

School staff experiences and recommendationsFull results are outlined in Tables 1 and 2 below.

Table 1 outlines the quantitative results recordedfrom closed questions. Table 2 shows categorised resultsof free-text questions.

Four topics were repeatedly referred to in the free textresponses. These were:

• Lack of clarity over how to support students with ED

• Lack of ED training and policies available in schools

• Staff feel uncomfortable teaching students about ED

Table 2. Summary of Staff Responses to Eating Disorders (ED) Experience Survey – Free Text

Benefits of EDtraining (142respondents)

Increased confidencesupporting ED

Learnt how tosupport sufferers

Learnt EatingDisorderwarning signs

Sharingideas/experienceswith others

GenerallyUseful

39 (27%) 31 (22%) 21 (15%) 15 (11%) 14 (10%)Learnt aboutreferral processes

Raisedawareness of ED

Not useful

12 (8%) 7 (5%) 3 (2%)What would havemade trainingmore useful?(96 respondents)

Longer/more in-depth More staffattending

Repeat, refresheror regular sessions

Case studies Training wascomprehensive

24 (25%) 17 (18%) 10 (10%) 10 (10%) 7 (7%)Practical supportsuggestions

More relevant tospecific student

Bettertrainer/presentation

Policy/referrals info Smaller groups

7 (7%) 6 (6%) 6 (6%) 5 (5%) 4 (4%)What you would doif you had EatingDisorder concernsabout a student(782 respondents)

I don’t know Refer tocolleague/Followpolicy

Seek advice fromcolleagues

Talk to the pupil Work withparents

316 (40%) 168 (21%) 146 (19%) 107 (14%) 25 (3%)External referral Monitor pupil13 (2%) 7 (1%)

Reasons some staffwould feeluncomfortableteaching aboutEating Disorders(546 respondents)

Lack of knowledge It would lead to arise in eatingdisorders

Students alreadyhave a goodunderstanding

Worriedabout difficultquestions/disclosures

312 (57%) 109 (20%) 64 (12%) 61 (11%)

Experiences ofcommunicatingEating Disorderconcerns withparents (781respondents)

Denial/Refusal tocommunicate/cooperate

Mixed reactions First contactdifficult, butbecame supportive

Anger – parent thinksit is an accusationof poor parenting

364 (47%) 287 (37%) 112 (14%) 18 (2%)

Support that wouldbe useful whenreintegrating astudent followingabsence due to anEating Disorder(105 respondents)

Information aboutthe specific case

Increasedquantity/qualityof training

Involve morestakeholders

All relevant staffto receivetraining/support

Ongoing help& support fromprofessionals

30 (29%) 25 (24%) 17 (16%) 13 (12%) 8 (8%)Prepare peers forpupil return

Other

8 (8%) 4 (4%)

All questions were optional. When not all participants recorded a response to a question, percentages were calculated according to thenumber of respondents to the specific question.


doi:10.1111/camh.12039 We don’t know how to help 3

• The reintegration of students following absenceneeds specific support

Lack of clarity over how to support students witheating disordersAlthough the majority of participants had encountered astudent with ED in their school, 40% (n = 316/782) ofstaff said they would not know how to follow up EatingDisorder concerns.

“We don’t know how to help. No one has told us what to say ordo and you’re always scared of saying the wrong thing andmaking it worse.” (Biology teacher)

Lack of ED training and policies currentlyavailable in schools41 per cent (n = 320) of respondents’ schools had no ref-erence to Eating Disorders in any policy. Only 5%(n = 41) of respondents’ schools had implemented spe-cific Eating Disorder policies, although the majority ofparticipants considered Eating Disorder policies to beeffective [61% (n = 317)].

“Having a policy in place has enabled us to clear up questionsover how referrals should be made and to whom. We no longerhave concerns about pupils slipping through the gaps.” (Headof pastoral care)

“An ED policy would be highly effective as long as it was writtenas a practical document and gave clear guidance.” (Maths tea-cher)

Of those who thought that Eating Disorder policieswould prove ineffective [31% (n = 160)], many cited thedifficulties of working with a policy designed by seniorstaff, but meant for implementation by teaching or sup-port staff:

“It would just be another box ticking exercise done by the headteacher to please the inspectors. There wouldn’t be anythingactually useful in it.” (Year 6 teacher)

“What usually happens with these things is that the seniorleadership team writes them and we’re all supposed to jump inline even though what they’ve put together is completelyimpractical and can’t be used for its intended purpose.” (Geog-raphy teacher).

74 per cent (n = 583) of respondents’ schools hadprovided no training on ED and of the 26% (n = 208)of respondents whose schools had provided training,in the majority of cases [56% (n = 82)], this traininghad been made available to three members of staff orfewer. Staff who had received training found it usefulfor a range of reasons, including increased confidencein supporting Eating Disorders [27% (n = 39)], asource of practical support ideas [22% (n = 31)] andan increased awareness of Eating Disorder warningsigns [11% (n = 15)].

“Being able to share ideas was incredibly helpful. I went awayfeeling more confident that I could provide good support topupils with EDs in the future.” (Head of PE)

“Now I know what to look out for I think I’ll be able to spot theearly warning signs and hopefully help move things on beforethe ED really takes grip.” (Head of Year 9)

Some of those who had received training felt that itcould be improved by being more in-depth [25%(n = 24)], available to more staff [18% (n = 17)] orrepeated on a regular basis [10% (n = 10)].

“I was left with more questions than answers, I felt like I’d juststarted learning. It was useful but I’d have liked a lot longer.Refresher sessions would be useful too as it’s a huge amount totake in.” (Assistant Head)

91 per cent (n = 316) of staff who had not receivedtraining said that they would find ED training useful orvery useful.

“This doesn’t feel like the sort of thing you should be learningon the job – we should get proper training. After all, there’s somuch potential to say or do something harmful completely bymistake.” (Learning support assistant).

Staff feel uncomfortable teaching students aboutEDMajority of staff felt either very uncomfortable [54%(n = 419)] or uncomfortable [35% (n = 273)] teachingtheir students about ED. A wide range of reasons weregiven for this – the most repeated being a lack of knowl-edge [57% (n = 312)]:

“It’s something I know so little about myself that it just wouldn’tbe appropriate for me to lead a class on it.” (French teacher)

Many teachers felt that it was inappropriate to teachstudents about ED because it may increase their preva-lence [20% (n = 109)]:

“My understanding has always been that if you teach a pupilabout ED, you give them the tools to develop that disorderthemselves.” (Year 5 teacher)

Others were worried about how they would answerstudents’ questions or deal with disclosures [11%(n = 61)]:

“I could probably teach a basic lesson but I’d be clueless whenit came to answering probing questions.” (Maths teacher)

“I’d be worried in case one of my students talked about their ED inclass. I wouldn’t know how to handle that situation.” (RE teacher)

Some teachers simply believed that it was unneces-sary to teach students about Eating Disorders as they



thought students already had a secure knowledge of thesubject [12% (n = 64)]

“What can I teach them that they haven’t already learnt fromHeat magazine or The Sun? They’re walking encyclopaedias onthis topic.” (Chemistry teacher)

“If anything, they should be teaching us. One of my studentsdid a project on anorexia recently, I learnt a lot from her.” (Year10 form tutor)

Around one third of respondents [37% (n = 287)] saidthat it had not been made clear to students what theyshould do, or whom they should tell if they were con-cerned about a friend’s eating behaviour.

The reintegration of students following absenceneeds specific supportThe majority [68% (n = 329)] of respondents reportedthat their school had had to reintegrate a pupil intoschool following a period of absence caused by an EatingDisorder. 24 per cent (n = 77) reported receiving no sup-port or advice about how to support the returning stu-dent.

“I will always feel guilty about it. We did our best to help her butwe’d had no support, no training, and ultimately we didn’t rec-ognise that things weren’t going okay. She was more clever inher deceit this time, she hid the signs better and told us whatshe knew we wanted to hear. She seemed more or less okay.She died in her sleep.” (Deputy Head).

76 per cent (n = 240) of respondents’ schools didreceive some form of training or advice; there were sev-eral suggestions about how this training could be devel-oped to be more effective. The most cited potentialimprovement was an increase in the quantity or qualityof training [28% (n = 30)].

“She’d been out of school 6 months – a 30 min briefing prior toher return wasn’t enough.” (Head teacher)

“We were provided with advice but it felt really generic anddidn’t answer any of our school specific questions. Above allwe were panicked about what to do at mealtimes.” (Formtutor)

Several respondents highlighted the need for tailoredtraining that prepared staff to deal with the specifics ofthe individual case [24% (n = 25)]:

“Every case is different, we needed to know exactly how wecould help her. Was she allowed to do PE? What should we sayif she asked to join the gymnastics team again? Did it matterthat she was spending hours on her homework? The trainingdidn’t answer any of these questions. It would have been help-ful as a general session for staff but it didn’t prepare us for thedifficult journey we had ahead of us trying to keep her in recov-ery.”(Head of pastoral care)

Other respondents felt that the training should involvea broader range of people – including parents, pupils

and the health provider as well as teachers [16%(n = 17)]

“In the end we managed to help him fight his illness by workingtogether with his parents, friends and counsellor – the trainingcould have been a real opportunity to get us all in a room andfigure out how we were going to do it. Instead it was just amissed opportunity and we learnt the hard way.” (Head of PE)

Discussion

This study was the first of its size and type to investigateschool staff experiences of ED in the United Kingdom.Participants shared a wide range of experiences and alsomade recommendations about how school staff might bebest supported in helping young people with Eating Dis-orders.

The large volume of qualitative data available in thecurrent study provided a high degree of insight into theissues explored. However, the results of the currentstudy are based on a fairly basic content analysis – fur-ther studies could usefully expand upon the findings.

Participant characteristicsParticipants were recruited from a database of UKschool staff who had previously expressed an interestin mental health training. Therefore, there was a sam-pling bias, with the participants likely to have moreexperience of, or interest in, mental health issues thanaverage. Whilst their views may not have been entirelyrepresentative, participants were in a particularlystrong position to share insight into the experience ofsupporting pupils with ED. The responses generatedwere relevant, specific and included detailed descrip-tions of personal experiences across a range of scenar-ios.

The sample represented a wide range of schools withinthe United Kingdom, with the majority of respondentsfrom secondary schools. This bias towards secondaryschools reflects the typical teenage onset of ED.

Participants’ roles within schools were varied andincluded support staff, senior leaders and class teach-ers. The broad spectrum of roles represented lendsweight to the representativeness of the current study.

Eating Disorder prevalenceRecent prevalence estimates in adolescents (Swanson,Crow, Le Grange, Swendsen, & Merikangas, 2011;Machado, Machado, Gonc�alves, & Hoek, 2007) suggestthat ED affect every secondary school in the United King-dom. Therefore, it is of importance that staff areequipped to respond appropriately to pupils causingconcern. Our findings indicated that this is not the case,as 40% of respondents said ‘I don’t know’ when askedwhat their next steps would be if they had Eating Disor-der concerns about a pupil. This is in line with earlierstudies (Piran, 2004), but is worrying, given the vital roleof early intervention in improving Eating Disorder out-comes (Treasure et al., 2010).

Access to trainingMajority of staff in the current sample did not have anytraining about Eating Disorders and where training was



provided it was often delivered to small numbers of staff,limiting its reach and impact.

Lack of teacher knowledge and confidence has beencited in past studies as a major barrier to Eating Disor-der prevention and intervention (Price, Desmond, Price,& Mossing, 1990; Yager & O’Dea, 2005). Those staff whohad attended training, cited an increase in Eating Disor-der knowledge and confidence as key benefits. Partici-pants specifically found that being briefed about EatingDisorder warning signs was helpful and welcomed prac-tical strategies that they could implement at school.Some suggested that training should be more in-depth,made more widely available and/or repeated on a regu-lar basis. However, pressures of time and resourcesavailable for continuing professional development andcompeting demands on school staff to develop their skillsand expertise in a wide range of areas need to be consid-ered (Kennedy &McKay, 2011).

Nearly all respondents who had not had access to EDtraining said that they would welcome it. Other studiesfrom the United States and Canada have shown similarresults (Neumark-Sztainer et al., 1999; Piran, 2004).

School policiesVery few schools had an Eating Disorder policy in place,either as a stand-alone policy or as part of another pol-icy. Several respondents highlighted that a lack of stan-dardised policies or procedures surrounding EatingDisorder referrals could lead to pupils ‘falling throughthe gaps’ with staff failing to address their concernsappropriately. School staff may find it helpful if clearreferral pathways were set up within school with anamed person being made responsible for mentalhealth. Where school policies are implemented, respon-dents made it clear that these would be effective only ifthey were highly practical in nature and appropriatelydisseminated with briefing or training.

Teaching students about EDIn addition to a lack of confidence in following up EatingDisorder concerns, respondents were uneasy about theidea of teaching lessons about ED. Their concern waslargely due to a lack of knowledge, which could beaddressed easily through training. Many of the schoolstaff we surveyed considered the teaching of ED inappro-priate for students, believing that it may lead to anincrease in cases. There is evidence that some strategiesfor teaching about ED may increase body dissatisfactionor Eating Disorder symptoms (Yager, 2007; Carter,Stewart, Dunn, & Fairburn, 1997; O’Dea, 2000). How-ever, teaching students about ED within appropriateguidelines or as part of a positive body image programmeshould have more positive than negative outcomes(O’Dea, 2000). This is in line with UK government recom-mendations following a recent report, which suggestedthe need for mandatory body image and self-esteem les-sons for children at primary and secondary school (AllParliamentary Group on Body image, 2012).

Teachers can play an important role in dispellingmyths associated with weight loss and ED and empha-sise their severity as serious psychological disorders(O’Dea, 2000, 2005). It is also important that pupils aretaught how to support a friend whomay be causing themconcern – in a parallel study many students said thatthey did not alert a member of staff about a friend’s dis-

ordered eating simply because they did not know whomto tell and did not know whether the situation would betaken seriously (Knightsmith et al., in press).

Student reintegration following illnessA majority of respondents reported that their school hadreintegrated a pupil into school following a period ofabsence caused by an Eating Disorder, but training andsupport around this issue were inconsistent. Relapse iscommon in people recovering from ED (Keel & Brown,2010), and returning to school after a period of treat-ment can be daunting for all involved. Several partici-pants in this study suggested that they would liketailored help, which would inform them exactly how tosupport the student who was returning. It was also sug-gested that the school should work alongside parentsand the healthcare provider to support the pupil as ateam and that staff should be made aware of relapseindicators. The importance of clear lines of communica-tion with the student’s healthcare provider was high-lighted so that the school had someone to whom theycould turn if they had concerns.

Implications and core recommendationsED were encountered by a majority of school staff in thecurrent sample. Despite this, many school staff reportedthat they were ill-equipped to support students at risk of,or suffering from, EDeither in the early stages of the disor-der or during the recovery period. Many staff had receivedinadequatetrainingornoneatall andwouldwelcomemorein-depth, practical training tailored to the school environ-ment. However, such enthusiasm for training must betempered with the need to fit within school curricula aswell as time and budgetary constraints. The efficacy of ashort (1 day or less), but highly focused, ED training pro-gramme aimed specifically at school staff would be worthexploring. Ideally, such a programme would specificallyaddress the most common warning signs for ED, how tofollow up on Eating Disorder concerns with students andparents and look at ways in which schools can supportpupilsduring the recoveryperiod.

Some participants in the current study encouragedthe designation of a person responsible for ED (or per-haps all mental health issues) to whom all cases shouldbe referred to prevent pupils falling through the gaps.Some schools may find the adoption of a specific EatingDisorder policy useful, providing it is highly practical innature and implemented effectively.

School staff felt uncomfortable teaching pupils aboutED and expressed some valid concerns. It is clear fromcurrent research that it is possible to cause harm whilstteaching students about ED, which has resulted in guid-ance on what not to do (Yager, 2007). However, schoolstaff can play an important role in dispelling myths pur-veyed by the media and educating young people that anEating Disorder is a serious psychological illness. Futurestudies are needed to look at how school staff can mostappropriately teach comprehensive practical guidanceon this difficult subject.

Acknowledgements

This work was supported by the National Institute for HealthResearch (NIHR) under its Programme Grants for AppliedResearch Scheme (RP-PG-0606-1043). Ulrike Schmidt receives



salary support from the National Institute for Health Research(NIHR) [Mental Health Biomedical Research Centre] at SouthLondon and Maudsley NHS Foundation Trust and King’s Col-lege London. The views expressed herein are not necessarilythose of the NHS, the NIHR or Department of Health. Theauthors would like to thank the young people who participatedin the study, and the school staff and parents who supported.The authors have declared that they have no competing orpotential conflicts of interest.

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Accepted for publication: 25 June 2013



School staff experiences of eating disorders - academic journal article

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