What makes a 'good mother'? It’s an impossible question to answer, but if we asked people to name ten things that make up a definition, I'd bet next month's salary that food would feature. It starts before birth – are we eating the right food to nourish our unborn child? Should we breastfeed or not? When to wean? Is dairy okay? What about nuts? How much sugar is too much? It's not just what we eat that is subject to scrutiny, but how we eat. Around a table with TV switched off? Good mother points. Slumped on a sofa, chewing pizzas in front of Eastenders? Bad mother points. Our children are measured from birth and their weights are plotted on charts. In the high centiles as a baby? Excellent work, you have a bouncing, bonny bundle of joy. Still in those high centiles on starting school? You know childhood obesity is a serious problem, right?
What nobody tells you is that one day, your child may decide to starve themselves to death, purposefully and deliberately. That all your worries about whether they ate potato shapes or drank too much juice will pale into insignificance, as you watch them getting smaller and paler, gripped by an illness so terrifying no description will ever convince you it's real unless you see it for yourself. Imagine your child possessed by a demon, screaming and hurling the food they once loved and devoured, sobbing at how huge and disgusting they are when you can count each bone from a distance. Years after toilet training stopped, you have to supervise them in the bathroom again, to make sure their fingers aren't jammed down their throat to vomit the food back up. Anorexia was the diagnosis given to my daughter L in 2012. She was the sensible one, the high achiever, always baking for friends, helping around the house and sorting out other people's problems. And she spent a total of 14 months in hospital or day care programmes, lost a year of schooling, come close to being sectioned and fed through a tube, and turned into a human being we scarcely recognised. Someone once told me all you needed to do was love your child and they would be fine. They were wrong.
The government's announcement of £150 million to be spent on improving eating disorder services for young people is welcome, but it’s shockingly overdue. The mortality rate from anorexia is estimated at a wide range of levels, in some studies up to 17%. Put crudely, L had a better chance of surviving Acute Lymphoblastic Leukaemia. The stated rationale for this investment is to prevent long, expensive hospital stays and speed up access to treatment. I'm trying not to be cynical, so if I had a magic wand and the £150 million, this is what I'd do:
1. Educate every person working with young people, not just mental health professionals. It isn't acceptable to sit in a GP's office with a daughter who has a BMI of 17.6, has stopped menstruating, admits to purging and be told "just don't lose any more weight, but it's probably not a good idea to try and gain weight". Everyone needs a basic grasp of eating disorders, their symptoms and how to access help. This will also help tackle some of the myths: silly, vain girls who diet too much; families in crisis cause anorexia; you can catch it from too many magazines with stick thin models.
2. Think in a joined up way about what health promotion campaigns are supposed to deliver. Irony gets no grimmer than sitting in a CAMHS waiting room, staring at a Change4Life poster trilling "Could a little less on your plate help you get more out of life?" next to a severely underweight teenager. Many restrictive eating disorders are triggered by dieting, which in turn is triggered by constant scrutiny of shape and size. The experience of being underweight can in itself cause the obsessive behaviours and thoughts which typify eating disorders. A healthy weight has a minimum as well as a maximum.
3. Proper community support. The process of ‘re-feeding’ an anorexic takes three meals, plus snacks, each of which can take several hours. A lifeline for us was the offer of home visits to supervise meals. This was only for a few weeks, but it was the best support we ever had. Health Care Assistants visiting homes and helping parents in the techniques of coaching their children to eat could be transformative - not only to the mental health of the child, but the parents, too. Many children are admitted to hospital because their parents are too exhausted to continue.
4. Set standards in referral times. If you think your child is starving to death, being told to wait a few months for an appointment is unacceptable.
So, there - I've tried to be sensible and positive, and think about practical ways forward so that others don't go through the same things as us. But on bleak days, I still want to make a bonfire of every set of bathroom scales that ever existed. I want to go back into the delivery room and demand that my daughters (L is a twin) are not weighed, ever. Today L is in a better place. She still hasn't menstruated properly for three years, meaning her bones are likely to be less dense, like Crunchie bars with much bigger holes. But she can eat without a physical fight being put up. I feel relieved that the government may finally be taking this awful disease seriously, but for me, the jury is still out.