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To Vice Chancellor

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Dear Vice Chancellor,


Eating disorders are becoming increasingly prevalent in society, a trend which has only been exacerbated by the recent COVID-19 pandemic. According to the Oxford SU (2016) report at least 5 percent of the student population experience an eating disorder of some description; meaning approximately 1200 students at Oxford University struggle with an eating disorder.[1] Characterised by the highest mortality rate of any mental illness[2] - the situation has become critical.

It is no surprise that coming to University can exacerbate eating disorders among students. In essence, it presents a particularly unique challenge. For many young people, it marks the first occasion where they live alone and are in control of their own choices. As a Fresher, especially with an eating disorder, it can be even more difficult managing the condition, whilst also staying accountable in recovery and ensuring they consume a nutritionally balanced diet.

Through the pandemic, Beat (the UK’s eating disorder charity) have reported an 81 percent increase in demand.[2] As much as this charity can act as a lifeline for those struggling with eating disorders, their work is designed to complement, as opposed to replace, quality care, such as that provided by specialist eating disorder services.

Strangely, for a University well-known for its groundbreaking research into the treatment of Anorexia Nervosa, Oxford has amongst the highest burden of care. Cotswold House, a tertiary referral centre for adult eating disorder care covering three counties, has been forced, due to a lack of resources, to only accept referrals for severe or extreme Anorexia Nervosa (AN) or Bulimia Nervosa (BN) (classified by DSM-5 diagnostic criteria[3])[4]. Even those patients whose referrals are accepted are likely to face long waiting times - increasing from 12 months to 25 months over the last year alone.[4] From this, we can conclude that getting sufficient help for an individual is becoming increasingly difficult, as services are being stretched beyond their limit of capacity. It is important to note that the physical criteria for an individual to be accepted for a referral to Cotswold House eating disorder treatment is the same criteria below which a student fails the Fitness to Study guidelines.[6] This begs the question, how can students begin to recover from their eating disorder and be eligible for treatment, whilst at the same time be deemed unfit to remain in Oxford as a student?

Sadly, anecdotal evidence[7] suggests that many students are being lost in the system, left to struggle alone with a lack of trained and knowledgeable staff, insufficient policy in place to manage students with eating disorders of varying severity and no clear path forward for those waiting for NHS treatment. Surveys suggest that many students are turned away, citing their problems as being ‘too complex’ to be treated by the University Counselling Services, despite no way of accessing specialist eating disorder support. We have spoken to students with eating disorders who had tried to engage with University Counselling Services and college nurses, 70 percent of whom expressed feeling that the counsellor or nurse did not have sufficient experience with eating disorders[7].

We implore that the university must take steps in increasing the provision of specialised support for those affected by eating disorders. Through a recent survey[7], we have established a number of achievable steps which we recommend to the University.

Though mental health specialists are no doubt valuable to the University community, those with experience and expertise in eating disorders are critical in affecting real change in this area. Eating disorders are complex, serious mental disorders, therefore it is imperative that students have access to someone who is trained to support those suffering from disordered eating[8]. Thus, we feel it is imperative that college nurses across the University are trained in the management of these complex illnesses, which not only require physical health monitoring, but a measured approach to recovery. This can be done by facilitating training for staff using the ‘Bridging the Gap’ course for University staff provided by BEAT.[9]

We feel that provision of a dietician with specialism and experience in working in eating disorders would be a tremendously valuable addition to the University Counselling Service. Amongst most Universities, the Oxford catering options remain charmingly unique. Students have suggested that a University-based dietician would have a greater understanding of catering options available to undergraduates and a better comprehension of the workload undertaken by students during an Oxford term. One student expressed, “I struggled to make food because I was barely able to finish my work.” Therefore, it is imperative that dieticians working with students understand the unique situation to which they find themselves and are able to address these challenges in a timely and effective manner. Dietetic input is an essential aspect of eating disorder treatment and support, and can support individuals, preventing physical deterioration. Ultimately, this service could act to prevent students becoming medically unfit to study and/or requiring emergency medical attention. This provision, we feel, would go part way in achieving the multi-disciplinary treatment required for students affected to overcome their disorder, which commonly requires a combination of psychotherapy and dietetic input, as well as psychiatric evaluation.

Further, the establishment of student-led peer support groups would be a highly valuable addition to the University support systems already in place. Student Minds, the UK’s student mental health charity, has resources to train students to lead support groups in their Universities. However, due to Oxford’s much shorter terms and that undergraduate students are not allowed to undertake part-time employment due to the time-intensity of a degree at Oxford, it becomes much more difficult to establish a support group run by student volunteers. We feel that the University must play a key role in facilitating such groups through the employment of a specialist mental health nurse or therapist with experience working in the field. Ideally, this would allow students, both with and without a diagnosis, to access specialist support.

As one of the most-highly ranked Universities in the world in the field of Medical Education, it is imperative that the curriculum reflects this ever-growing societal pressure as recommended in the PACAC inquiry into avoidable deaths[10], and in a report published by BEAT[11]. We feel that Oxford has the opportunity to lead the field in educating future doctors, not only about the physical, but mental implications, of such life-limiting illnesses. In failing to address these issues, we are, in turn, failing to prepare our future doctors, and in turn, failing their future patients.

We ask that you, as a University, engage with Oxford Beat Society on an ongoing basis to implement achievable and effective next steps.

Personal Experience of a current student

“I had to suspend my universities twice after my condition (anorexia nervosa) deteriorated to the point of it being unsafe for me to remain at university whilst I was awaiting treatment from the local eating disorders service. I felt alone and misunderstood in managing my condition when I tried to approach the college nurse, college counsellor, disability services and counselling services, which made me much more vulnerable to deteriorating. In my second year at Oxford, I was finally allocated the specialist mentor most experienced in working with eating disorders after my previous disabilities mentor struggled to understand how my condition impacted my studies. This was the first year I managed to complete my studies without my condition drastically deteriorating.

I strongly believe that if I had had access earlier to university staff trained in eating disorders, it would have helped prevent the deterioration of my condition and also decreased the longevity of my eating disorder (7 years), which has had an extreme negative impact on my quality of life.”

[1] Oxford University Student Union, 2016, Welfare Report
[2] BEAT (2020). ‘Statistics for Journalists’
[3] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA, American Psychiatric Association
[4] Cotswold House Eating Disorders services (2020). Personal communication. 28th October
[6] HEOPS Fitness to Study guidelines produced for Oxford University
[7] Oxford BEAT Student Survey (2020)
[8] NICE guidelines for Eating Disorders Treatment (2020)
[9] BEAT, Bridging the Gap
[10] House of Commons, PACAC inquiry (2017-19). Ignoring the Alarms follow-up: Too many avoidable deaths from eating disorders
[11] BEAT report The crucial role of GPs

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Signers list

Hanaa Haseebah Asharaf
Erica Spencer
Finlay Waddell
Daisy Makin
Ruoyi Wang
Sophie Mcdonald
Kate Shore
Emily Luo
Beth Whell
Tess Hovil
Olivia Strachan
Aidan Kirk
Eva Zilber
Alex Fish
Emma Gillard
Alice Connor
Orla Mccormack
Joshua Rudloff
Holly Jackson
Elizabeth Biggs
Oliver Bostridge
Luke Moss
Ken Yeow
Sophie Davis
Julia Ramírez
Helen Durán
Maia Gibb
Augustine Allain-Labon
Susannah Dowsett
Anja Stares
Luke Bateman, Academic Affairs Rep For Merton College Jcr (2021-21)
Jennifer Knight
Rebecca Harry
Grace Burney
Emily West
Zuleika Frost
Joel Summerfield
Elizabeth Evans
Helen Micheal
Catrin Haberfield
Ellen Fernley
Kate Patrick
Oliver George Spacey
Juliet Shapiro
Anna King
Karolina Wolska
Sarah Stubington
Lewis Hardie
Thamima Choudhury
Alexandra Lindsay-Black

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