Bipolar Support Groups.com blog

Usually, the first steps to getting help if you feel you are having problems with your mental health is visiting your general practitioners’ (GP) surgery. A GP is a doctor who can provide treatment and care for your physical and mental health. This section provides information on what to expect from the appointment and what your GP can do for you.
•GPs can provide treatment for mental health problems and offer ongoing care and support.
•Sometimes it is worth asking whether there is a particular GP at your surgery who has an interest or speciality in mental health problems.
•Before an appointment, it can be helpful to write down a list of things you’d like to ask or discuss with the GP. This could be writing down a list of symptoms or perhaps side effects from medication.
•A GP will ask you questions about your mental and physical health and may make a diagnosis.
•You can change GPs providing it is within your catchment area.

This section covers:
•Preparing for a GP appointment
•What happens at an appointment
•What to expect next

Preparing for a GP appointment

The first steps to seeing a GP is to register with your local surgery or practice, if you are not already registered with one. You can find your local surgeries on the following NHS Choices page or by calling NHS 111 on 111.

You will need to be in a surgery’s catchment area, with the local area usually determined by postcode or address. You can register via a form that you can pick up at the surgery’s reception area or you can sometimes do this on their website. Once you are registered, you can then make an appointment to see someone. Usually, there are different GPs who all work in the same surgery, alongside other professionals such as nurses and therapists. You can make an appointment to see the first GP available, or if you are a returning patient then you can arrange to make an appointment with someone you’ve already seen, or a particular GP you prefer.

You can ask the receptionist if there is a GP with a specialist interest in mental health and request to see them. You can request to see a male or female GP. You do not need to tell the receptionist what you are making an appointment about. If they ask, you can explain that you’d prefer not to say, if you’d rather.

Sometimes you can see a GP through visiting local health centres that provide a walk in service. Information on where to find these services can be found in the useful contacts section.

Before the appointment, it can be helpful to write down a list of things you’d like to ask or discuss with the GP. This can be especially useful if you are feeling particularly anxious or worried, and could help you remember to ask something which you feel is important. You could consider writing down a list of your symptoms, and noting whether they might get worse at certain times or when doing certain things.

You might want to think about how you’re feeling and how your mood might be affecting your day to day life. A useful way of noting this sort of information can be a mood diary. We have included a sample mood diary here, which you may want to use or adapt for your own purposes. It could also be useful to make a note of any medication you might currently be taking.

You are entitled to take someone along to the appointment if you feel this would be helpful, such as a close friend, relative or advocate. If you wanted, you could bring someone along with you to the surgery for support while you are waiting but go into your appointment on your own.

At some surgeries you can arrange a telephone appointment where a GP will contact you over the phone to discuss your problems or any follow up care. If this is more convenient for you then you could check with the
surgery, although some GPs might still ask for you to visit them directly to discuss matters face to face.

The waiting time for an appointment to see a GP can vary. This depends on how busy the surgery is. If you need to be seen urgently, then you may be able to arrange an emergency appointment through the surgery’s reception. If you prefer to see someone particular then you might have to wait until an appointment slot becomes available.

Please see our checklist here, which you might find useful for filling in to take along with you to an appointment.

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What happens at an appointment

During the appointment, it is important to be as honest as possible and to give the GP as much detail as you can about how you’re feeling or how the symptoms are affecting you. They will ask you questions about your mental and physical health and may make a diagnosis.

A GP usually has an average of around ten minutes to spend with a patient. For some, this time can be too short and you might feel that you can’t get everything across during this time period. You can arrange a ‘double appointment’ if you feel you have a complex problem or need to discuss a number of things.

There will be a range of options that the GP will consider in getting you help. This might include prescribing medication, making a referral to a talking therapy service, referring you to a specialist mental health team or providing advice on maintaining your overall wellbeing.

NICE (National Institute for Health and Care Excellence) produce guidelines for NHS services on how they should manage certain conditions. Guidance can be downloaded from their website. These can be useful in letting you know what is recommended and how a GP should manage your treatment and care.

It is always worth asking why a certain treatment is being offered and whether there are other things that could help you to get better. If you are given any medication, your GP should tell you how it is expected to help and about any side effects that may occur. You may wish to ask about further information or whether there are any local support groups to help with how you are feeling.

You can also take this opportunity to ask for advice on:
•Smoking
•Alcohol or drugs
•Exercise
•Diet
•Flu jabs

A note of what was discussed at the appointment will be made. This will be recorded on your medical notes but will be kept confidential. Further information can be found in our Confidentiality section.

It is worth noting that although treatment and care through your GP is free, you may need to pay for prescriptions if you require medication.

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What to expect next

You can arrange a follow up appointment with your GP to see how things have progressed or to review any treatment options. You can ask to arrange the next appointment whilst with the GP if you’d prefer. If you have been prescribed medication then this should be closely monitored with regular check ups to see how it is working and how you are feeling. If there are any problems with treatment, or if your symptoms start to get worse, then you should make an appointment so that you can discuss these matters. Your GP may need to refer you onto a specialist under secondary mental health services to seek further or more experienced help. This is usually if a GP has tried all options and symptoms of your condition persist, if your problems seem too complex for the GP to deal with or if you are at risk of suicide or self harm.

If you have been referred onto mental health services, your general care needs including physical health should still be overseen by your GP. Your GP should liaise and work closely alongside mental health services and may accept recommendations from them. If you were previously under the Care Programme Approach (CPA) and have been discharged, then your GP will continue to provide your care and will be responsible for overseeing your health needs.

If you have a severe mental illness, such as schizophrenia or bipolar disorder, your GP should carry out a physical health check for you annually. Research shows that people with severe mental illness are at higher risk of certain physical health conditions. GP surgeries usually hold a register of all patients at the practice who have severe mental illness (schizophrenia, bipolar disorder and other psychotic conditions), which reminds the GP or nurse to contact you when a check is due. A health check may include taking your blood pressure, taking your pulse, doing a urine or blood test or weighing you. Further information can be found in our wellbeing and physical health section.

PROBLEMS WITH YOUR GP

Most people find that their GPs are supportive and proactive in their approach to helping and supporting with mental health problems. However, in the experience of our Advice and Information Service, some find that their GP do not take on board such problems and can be unsympathetic towards their needs. If this is the case, you could consider seeing a different GP. You can check whether there is a GP at the surgery with a particular interest or speciality in mental health then arrange any follow up appointments with this person afterwards. You can do this by checking with the receptionist.

If there is not another GP at your surgery that you felt comfortable seeing or if you would like to change surgery, you could also check whether there is another one in your local area. You can do this providing it is within your catchment area.

An advocate might be useful in helping you explore these options. An advocate is someone independent from health services who can help to make your voice heard with problems you may come across. There may be a local advocacy service in your area which you can contact for support. You can search online for a local service.

GP surgeries have to be flexible to help people with mental illness. Sometimes you might want to ask for changes in the way they support you.

For example you could ask to:
•Be able to book appointments later in the day. If your surgery only offers same-day appointments, you might usually have to phone first thing in the morning. If you are on certain medications you may not be able to get up at this time. You could ask to be able to book the appointment later.
•Receive appointment reminders if you think you might forget your appointment due to your condition. The surgery could send you a text or give you an appointment card.
•Wait in a different waiting area, maybe where it’s quieter. If you find it difficult to wait for your appointment with other patients, it is reasonable to ask for this.
•Have a longer appointment. You are entitled to ask for this.

If you need to, you could mention that surgeries have to make these changes because of the Equality Act 2010. They are called ‘reasonable adjustments’. More information can be found in our ‘Whats reasonable? GP Toolkit’.
If you feel unhappy with how your care is being handled, then the Patient Advice and Liaison Service (PALS) could be contacted, who can try to resolve any problems or questions you have. Their details should be available to you at the surgery, but you can also find your local office details through this website. If you wish to put in a complaint about a particular GP or surgery then your PALS will also be able to advise you on this. Further information can be found in our Complaining about the NHS or social services section.

The National Service Framework for mental health sets out basic standards for meeting the mental health needs of adults up to the age of 65. Standards two and three of the framework outline the standards by which mental health needs should be treated under primary care services (this includes your GP). These state that someone should have their needs identified and assessed and be offered effective treatments or appropriate referrals to meet these needs. If you feel that a GP has not offered effective treatment or considered your case properly then you might wish to consider these standards in formulating a complaint.

WHAT A CARER FRIEND OR RELATIVE CAN EXPECT

If you are a carer, friend or relative of someone and are worried about their mental health, you may wish to share information with their health professional, such as their GP. Unless the person consents, confidential information about them cannot be discussed, except in very limited circumstances.

There is no rule that says a GP cannot listen to your concerns, as this can be helpful for providing appropriate care. However a GP would not be able to tell you whether they took any action, and they might also talk to the patient about the conversation that took place. This is stated in the General Medical Council guidance on confidentiality for doctors. Further information can be found in our Confidentiality and information sharing – for carers, friends and family section. You could discuss with the person who is cared for about completing a consent form about information they permit to being shared. This could then be given to professionals involved with their care.

If you have concerns about someone you know but who are refusing to seek help, then you may wish to read our Are you worried about someone’s mental health section.

Complementary therapies are a diverse range of health-related treatments which are not part of mainstream medical care. Generally speaking they are thought to increase well-being, aid relaxation and promote good mental health in all. They are also known as alternative, natural, non-conventional and holistic and can also be known as medicine, e.g complementary medicine.
•Rethink Mental Illness believes that complementary therapies can be beneficial to people experiencing mental health problems when used in addition to medical treatment.
•The effectiveness of complementary therapies is not well researched.
•There is evidence that St Johns Wort can be effective in treating depression.
•The National Institute of Health and Clinical Excellence (NICE) has recommended the use of mindfulness based CBT (meditation) for depression.
•We look at a small selection of complementary therapies which are popular for the treatment of mental health problems but there are many more available.

Why use complementary therapy for mental illness?

It is widely thought that complementary therapies can provide a sense of relaxation and increased well being which can contribute positively to a person’s mental health.

Furthermore, many complementary therapies involve a more holistic approach to treating people which means to treat the whole person and consider physical, psychological and spiritual needs rather than focussing on the symptoms of the illness. Many people with mental illness find this beneficial and Rethink Mental Illness supports a holistic approach to treating patients.

We will look at some of the most popular and established complementary therapies, in alphabetical order, and consider their usefulness for some mental illness. However, please note that this is not an exhaustive list and there may be other therapies available which work for you.

•Acupuncture
•Aromatherapy
•Homeopathy
•Massage
•Spiritual/Energy Healing
•Western Herbal medicine

Acupuncture

Acupuncture is part of what is often referred to as Traditional Chinese Medicine (TCM). Acupuncturists believe that illness occurs when the body’s “qi”, or “vital energy”, cannot flow freely. By inserting ultra-fine sterile needles into specific acupuncture points, an acupuncturist seeks to re-establish the free flow of “qi” to restore balance and trigger the body’s natural healing response

A review was carried out into the use of acupuncture to treat depression. Two of the trials reviewed found that acupuncture could provide an added benefit to medication, when compared to medication alone. Overall, there was not enough evidence for the review to recommend acupuncture as a treatment for depression.

A review was also carried out into the use of acupuncture for people with schizophrenia. Some of the studies did suggest that acupuncture combined with antipsychotic medication may be more effective than antipsychotics alone. However, the research reviewed was uncertain so there was not enough evidence for the review to recommend acupuncture for people with schizophrenia.

Aromatherapy

Aromatherapy is the use of aromatic (pleasant-smelling) essential oils which are extracted from plants such as flowers, leaves, roots or bark. It is thought that each oil has a different therapeutic property which can be used to improve health and well being. Certain oils are historically linked to symptom relief for a wide variety of mental and emotional symptoms such as depression, anxiety and insomnia. Aromatherapy oils are absorbed through massages, bathing or direct inhalation.

A small study looked at a group of people with anxiety and/or depression who received massages with oil that contained essential oils associated with symptoms such as anxiety and depression. This group was compared with another group of people with anxiety and/or depression who received massages with oil that did not contain these essential oils. The results suggested that the group that received the essential oils showed more improvement in their anxiety and/or depression symptoms than the other group.

There is very little research into the effects that aromatherapy can have on conditions such as schizophrenia.

Homeopathy

Homeopathy is based on the theory that an illness can be treated by using tiny amounts of a substance which causes similar symptoms to it. Homeopathy is also based on the principles of treating the whole person and a consultation would involve a thorough assessment of a person’s lifestyle, personality and physical health. A treatment is then selected based on all the information gathered and is tailored for the individual

A recent NHS review of evidence concluded there was still not enough evidence to recommend the use in depression.

Massage

Massage is a form of structured and pressurised touch, or kneading, of the body which is generally used to relax and to relieve muscle pain. There are many different types of massage ranging from “Swedish massage” which involves light strokes aiming to relax the muscles in order to relieve tension to “Shiatsu” which, like acupuncture, believes that putting pressure on certain points will help to balance a person’s energy. Often massage is combined with aromatherapy which is thought to enhance the well being effects of the treatment.

Spiritual/Energy Healing

People who practice energy healing believe that in addition to a physical body we also have an energy body. This is made up of individual chakras which are responsible for different aspects of our emotional and physical well being. When there is emotional or physical disharmony in a person these chakras become blocked or unbalanced. It is believed the practitioner acts as a channel and harnesses universal healing energy to unblock and balance the chakras. They do this by placing their hands above the body at certain positions throughout a treatment. One of the most well known forms of energy healing in England is Reiki.

Anecdotally many people report a strong sense of relaxation during the treatment and a feeling of well being afterwards. A study found that people who received Reiki appeared to have reduced symptoms of depression and stress after 6 weekly sessions compared a group of people that did not had placebo sessions. This difference was also present a year later.

There is little research into the effects of energy healing for people with mental illness.

Western Herbal medicine

This the use of plant extracts to treat medical problems including mental illness. The most well known herbal medicine for treating mental health problems is St. John’s Wort (hypericum). A review of studies that looked at St John’s Wort as a treatment for depression found that St John’s Wort is just as effective as anti-depressants and has fewer side effects.

However, the active ingredient in St. Johns Wort can be harmful for some people if combined with the substance tyramine which is found in some foods such as:
•extracts of meat and yeast (e.g. Oxo, Marmite)
•broad bean pods, smoked or pickled fish
•hung poultry or game
•some cheeses
•some red wines
•some beers.

Also, St John’s Wort can interact with other prescribed medicines such as the oral contraceptive pill. You should check with your doctor before taking St John’s Wort.

Reviews have been carried out to look at whether other herbal medicines, could be useful in treating anxiety. Valerian has been found to be as effective as diazepam, but only one small study could be reviewed. More research is needed to be able to say if this is an effective and safe treatment option for anxiety disorders. Kava may be an effective treatment for anxiety but again, more research is needed and its long-term safety needs to be studied.

Meditation and Mindfulness based CBT (MCBT)

There are different types of meditation however most share the practice of sitting quietly and focusing your mind on either your breath, a mantra (a repeated phrase) or an object. When thoughts arise the person is encouraged to gently note them without judgement and let them drift away whilst the attention is then returned to the breath or object. It is claimed that with practice people can learn to quieten a busy and stressful mind and gain a stronger connection to the present moment without unwanted thoughts intruding. This practice is widely known as “mindfulness” or “mindfulness meditation” and can be practiced at home on your own or in a group.

More recently the practice has been combined with some techniques of cognitive behavioural therapy to treat depression and this has come to be known as mindfulness based CBT (MCBT). Based on the principle that recurring depression is associated with the return of negative thinking, feeling and behaving, participants learn to recognise these ‘automatic pilot’ modes, step out of them and respond in healthier ways.

It is now recommended by the National Institute of Clinical Excellence (NICE) as a treatment option for depression . MBCT should be an 8-week group programme with each session lasting 2 hours, and four follow-up sessions in the year after the end of therapy.

There has been little research into the use of meditation in other mental illnesses.

Yoga is form of meditative and physical exercise which has its routes in India as a spiritual practice. Movements and postures are performed slowly and coordinated with an emphasis on controlling the breath. There are different types of yoga which often differ on how much emphasis is placed on aspects such as the physical exercises or the breathing.

Yoga practitioners claim that yoga can enhance all aspects of a person’s well being included mental health by reducing stress and improving mood.

OVERVIEW

•Electroconvulsive therapy (ECT) is not commonly used to treat mental illness and can be considered as rather controversial. Its use has significantly decreased in recent years and it is used far less than medication and talking therapies.
•ECT involves an electrical current being passed through the brain, causing a fit/seizure. This is done under a general anaesthetic and the use of muscle relaxants.
•Some people may prefer the option of a short course of ECT to taking medication long term.
•It should only be used for certain conditions – severe depression, catatonia (lack of, or excessive movement) or mania. It should not be used for the general treatment of schizophrenia.
•It is recommended only in severe cases when other treatments have been ineffective or the condition is potentially life threatening.
•ECT can have side effects, particularly memory loss. This is usually short-term, but people can experience memory loss for longer periods.
•ECT should not be given to you without consent and you should not feel pressured into giving consent. This also applies if you are ‘sectioned’ under the Mental Health Act.
•If you are too unwell to make a decision about ECT (known as lacking capacity), then it can only be given to you without consent with the approval of a Second Opinion Appointed Doctor (SOAD).
•You can make an advance statement on future decisions about treatment. If you have an advance statement refusing ECT, this cannot be overridden unless it is an emergency.
•ECT can be given in an emergency without consent after SOAD approval if it there is a risk to life, or to prevent a serious deterioration of your condition.

WHAT IS ECT

During ECT, an electrical current is passed through your brain, usually by electrodes attached onto your head (electrodes can be on just one side, or on both sides of your head). The electrical current travels through the brain causing a fit (seizure). ECT is not done whilst you are awake – it is given under a general anaesthetic and with muscle relaxants (to prevent body spasms).

It has never been fully understood how or why ECT works. A common belief is that ECT changes the way ‘chemical messengers’ behave in the central nervous system. This will change the way the brain functions.

ECT treatment is most often given in short courses, twice a week for 3-6 weeks (so usually involving 6-12 sessions in total). You may have further fortnightly or monthly sessions to keep you stable.

Why is ECT used?

ECT is used mainly within NHS hospitals (although some private hospitals may use the procedure) for people who are not responding to conventional treatments. It is used for:
•Severe depression
•Catatonia (associated with schizophrenia and mood disorders – usually total lack of, or excessive movement)
•Prolonged or severe manic episode.

Medications and ‘talking treatments’ are the first options for treating people with mental illnesses. The National Institute of Health and Clinical Excellence (NICE) recommends that ECT is only used when:
•ECT would provide fast or short-term improvement of symptoms in severe cases after all other treatment options have not worked

and / or
•Where the current illness situation is seen as potentially life-threatening.

NICE also recommends that ECT should not be used for the general management of schizophrenia or depression.

If you are very unwell, and ECT has been tried in the past and failed to work, ECT should only be used again if all other options have been considered. The risks and benefits of further ECT treatment would have to be weighed up. This should always be discussed with you and, where appropriate, your carer/advocate.

What are the side effects of ECT?

NICE recommends that you and your doctor should carry out an assessment of risks and benefits when ECT is being considered.

Many people report that they have a headache and aching muscles after ECT. Some people may also feel sick. The most common side effect of ECT is memory loss, which can be short- or long-term and affects about one in three people. Memory loss is usually short-term (affecting memories of the time just before and after the treatment), but longer term memories can be affected too. Memory loss may last days or weeks after the final treatment, and has lasted several months in rare cases.

ECT can affect heart rhythm and blood pressure. Some patients may be at increased risk of heart-related complications with ECT. NICE recommends that doctors should be especially cautious when considering ECT for pregnant women and older or younger people because the risk of complications can be higher for people in these groups.

Other rare, immediate complications include:
•Persistent seizure
•Laryngospasm – closing up of muscles which makes breathing difficult
•Peripheral nerve palsy – nerve damage which affects movement of muscles

The risk of death is the same as that of general anaesthetic. Patients should be told the health risks associated with the general anaesthetic during ECT.

You and your doctor should also think about the potential risks of not having ECT, such as the risk of detention under the Mental Health Act 1983, suicide, or being a danger to others. ECT is a way of treating severe symptoms more quickly than other types of treatment such as antidepressants, which may take several weeks to reach maximum effect.

You should be assessed for signs of side effects before each new session of ECT. This should include checking whether you have signs of memory loss, for example. If there are any signs of adverse effects from ECT, the treatment should be stopped immediately.

ECT CONSENT

ECT must not be imposed on you without your consent except in very limited circumstances. Doctors should not put pressure on you to consent to ECT, and you can stop ECT at any time by withdrawing your consent to treatment.

If you need to be treated in an emergency

If you are detained under the Mental Health Act 1983 (MHA), section 62 of the Act allows ECT to be used without your consent if:
•there is a real risk to life or
•to prevent serious deterioration of the condition

If you lack the capacity to consent

If you are detained under the MHA and you lack the capacity to consent to ECT, it can be given without your consent if a Second Opinion Appointed Doctor (SOAD) approves it. However, this is not the case if you have an advance directive refusing ECT, or if someone has the power to make treatment decisions for you and has refused it on your behalf.

The SOAD would need to sign a ‘Part 4A Certificate’ stating that ECT is appropriate for you. The SOAD must interview you, discuss your treatment with the doctor in charge of your care and consult two other professionals who are involved with your medical treatment. You should then normally be given written reasons for the treatment, unless this would cause mental or physical harm to you or anyone else.

If you are under 18

All people under 18 years old must be seen by a SOAD, who must agree that ECT is appropriate in order for it to be used. This is the case whether or not the patient is detained under the Mental Health Act 1983.

Advance directives

If you do not want to receive ECT in the future, you can make this clear in an ‘advance directive’. An advance directive is a written statement of the specific treatments that you do not want to have in the future. People write these statements in case they lose the capacity to make these decisions for themselves when treatment is needed. If you make a valid advance directive refusing ECT then it could only be used in emergencies under section 62 of the MHA (see above).

OVERVIEW
•Early intervention services work with you if you are experiencing a first episode of psychosis.
•Psychosis is a term used if you experience a break with reality. This can include having unusual beliefs or seeing or hearing things that other people do not.
•If you have psychosis and do not get help for a long time, you may have more episodes of psychosis in the future.
•Early intervention services have been set up so people can get help sooner and try to prevent these problems.
•An early intervention team will be made up of staff such as a psychiatrist, psychologist, community psychiatric nurses, social workers and support workers.
•Your GP can refer you to your local early intervention team. In some areas, you may be able to refer yourself or your friends or family could refer you.

Who is intervention for

Who is early intervention for?

Early intervention teams treat and support people who are experiencing psychosis for the first time.

Psychosis is a medical term. If you have psychosis, you might see or hear things, or hold unusual beliefs, that other people do not. It is not a condition in itself, but more a set of symptoms present in conditions such as
•schizophrenia
•bipolar disorder
•schizoaffective disorder

If you have symptoms of psychosis, medication (known as antipsychotics) and cognitive behavorial therapy (CBT) can help.

The National Institute for Health and Care Excellence (NICE) recommends that if you are experiencing psychosis for the first time, you should be offered early intervention services, no matter how old you are. You get support from an early intervention team for a limited amount of time. This is usually three years, but can be longer.

If you have psychosis and do not get treatment for a long time, you are more likely to develop longer-term problems. This can include becoming unwell again with more episodes of psychosis and also problems with your relationships or being able to work or study. Early intervention services were set up so that people could get help for psychosis earlier and to try and prevent these problems.

Feeling sad

Everyone will experience sadness from time to time in the ups and downs of everyday life. However, a persisting period of sadness could point to a mental illness, including (but not limited to) depression and anxiety.

Mental health issues are given names to help distinguish one group of symptoms from another

Find out more about different mental illnesses here – a sample of our information is below, the full list is on the left-hand menu.

Schizophrenia

Schizophrenia is a mental illness which affects the way you think. The symptoms of the illness can have an effect on how to cope with day to day life.
Learn more

Psychosis

Psychosis is when you have a break from reality. We look at what this means and its possible causes and treatments.
Learn more

Bipolar disorder

Bipolar disorder, also known as bipolar affective disorder, is a mood disorder. It can cause your mood to swing from highs (mania) to lows (depression).

Anxiety disorders

Anxiety disorders are some of the most common mental health problems. They make someone feel anxious all, or a lot of the time.

Where can I get treatment?

Your first step for getting help is usually through your GP. They can pass your details to specialist services or therapy if you need this.

There are different types of treatments for eating disorders, and you may be offered a combination of these.

If your body weight is very low, doctors will focus on increasing your weight before starting any therapy. You may stay in hospital or a specialist facility for this.

Talking therapies are often an important part of eating disorder treatments and may include counselling, cognitive behaviour therapy (CBT), interpersonal therapy (IPT), group therapy, and family therapy. The most suitable treatment for you will depend on your age, weight and situation. You can find out more about different talking therapies in our Talking Therapies section

Family support to help your family address any issues which may have led to your eating disorder and to support the family as a whole

Sometimes doctors will prescribe medication, such as antidepressants. However, it should not be the only treatment for eating disorders.

The National Institute for Health and Care Excellence (NICE) produces guidelines for the treatment of eating disorders. These guidelines recommend that if you have anorexia or bulimia you should be offered psychological therapy. This should be intensive CBT if you have bulimia.

Special forms of CBT have been developed for bulimia and binge eating disorder and you should be able to access these through the NHS.

There is no legal right to specific treatments on the NHS. However, you should get treatments that are recommended in the NICE guidelines unless your doctor has strong clinical reasons why not.

Family members should be included in treatments for all eating disorders. If you would like more information on the recommended treatments for eating disorders then please see the NICE guidelines for eating disorders. You can find these here.

According to the Royal College of Psychiatrists, more than half of people with anorexia recover after being ill for an average period of five to six years.

People who have the most severe cases of anorexia can die. This is less likely if you stay in touch with medical care. As long as your heart and other organs are not damaged, the other complications caused by anorexia will improve slowly when you are eating again.