"The process of accompanying a student with ED has been a great learning experience"

"It was the family who informed the school, in the second term of the first year of ESO in the 2020-2021 school year, that their daughter had an eating disorder, specifically anorexia nervosa. She started eating little at playground time and stopped using the lunch service (because that way they had more control from home), but we did not detect the disorder from the center. Academically, her grades improved, due to her great self-demand and self-pressure, which was increasing every time. From that moment on, the weight loss began to be very alarming and from the center we began to have very direct contact with the team of professionals who were caring for her, in order to provide the best possible support.

As a school board, we felt great bewilderment when we were informed that she had this disorder, and we really wanted to help in a situation that we didn't know how to deal with. We tried to maintain maximum normality with her and give her all the emotional support, so that she felt loved and comfortable in the days that followed. I think that when we heard the news, we were not aware of how the disease would evolve. Fortunately, most cases of ED that we find at the center have a good prognosis if they are treated by good professional support. In this case, our concern increased when we saw that her condition was not improving, but rather the opposite. First she started therapy, then she went to the day hospital, but then she had to be admitted for a long time to the Hospital Sant Joan de Déu Barcelona and, even, she stopped coming to school for a few months. The concern was high and from the center we tried to train ourselves so that her return to school was in the best possible way."

"She is a very sensitive student, with a very fragile self-esteem and very demanding of herself. During the first term of the first year of secondary school, which was when she more or less started with her disorder, we detected that she was in a convulsive emotional moment, and her extreme sensitivity made her feel vulnerable. She also had extremely small handwriting and presented her work with an extreme perfection that she was never satisfied with. However, in no case did we detect that she could have an eating disorder."

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"The TCA progressed very quickly. When she was admitted, our communication with her was only through emails. Once she returned to school, the hospital recommended that we maintain a relationship with her beyond the illness, because it was important that she felt like just another student. We did have to be alert and report any signs or suspicions to the hospital."

"We have had very frequent contact with the family from the very beginning. The tutors have communicated with the family almost weekly to find out about their condition and try to support them in the best possible way. A situation like this for a father or mother is very, very hard. We have experienced very intense, sad and complicated tutoring. We have also been very lucky with the family, because we have felt that they have been with us at all times and that, day after day, they have given us a lesson in life and courage. Faced with this, you have to find the strength to help, no matter what, from your own side."

"When we received the news, we informed our classmates that she would be absent from school for a while for health reasons. We were discreet with the information due to confidentiality issues. But at the beginning of ESO there was a moment in class when, without knowing exactly what was happening to her, but with the news that was circulating, the boys and girls were very worried and thought the worst. So we decided that it was necessary, having previously agreed with the family, to share in the classroom what their classmate's real situation was. The students, very curious, asked many questions. We accompanied the explanation with a little "training" on the TCAs. The communication was done through tutoring with the support of the school's Guidance and Support Department, which provided a more professional vision on the subject.

In this sense, his classmates have supported him with incredible maturity for boys and girls aged 12 to 14. They have understood his reactions, welcomed him and been by his side, understanding that sometimes he needed distance. And I'm sure it has also helped them, like us, to grow a little more."

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"Those of us who have been lucky enough to communicate with the professionals who work at the Sant Joan de Déu Barcelona Children's Hospital value this coordination as one of the most enriching learning experiences, both professionally and personally.

Estela Valdivia, who was his professor at the hospital, provided us with brilliant support in all aspects, both academically and emotionally. We communicated with her through calls, video calls and emails, and since the situation was very changing, we did so almost daily or weekly to see what was the best way for him to continue the course.

The student started by taking the instrumental subjects in the hospital classroom and then, little by little, we added the rest of the subjects. At first, they were very competency-based activities, which gradually acquired other dimensions. We compacted the tasks into a grid and shared online folders, where she marked what she did and what she didn't, and in this way we could also monitor and report back from the center.

It was very important to maintain very fluid communication in both directions, in order not to demand more from him, but at the same time to prevent him from missing the course or feeling that he was losing it."

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"When she was admitted to the hospital, it was important to be consistent in the work we proposed to her and in the feedback we gave her on the tasks, to avoid her becoming demotivated."

At school, we thought it was crucial that she find meaning in everything she was doing, in order to motivate her and make her want to move forward, so that she wouldn't throw in the towel, neither on her studies nor on her desire to heal. This involved hours of work and a great deal of involvement from the entire staff. It was a lot of work, but it wasn't the most difficult part. The most difficult part was returning to school."

"When he returned to school he was still in a very complex phase of his illness. The first day he came to class we were aware of its seriousness. Fortunately, we had received very clear instructions from the Hospital on what to do in many of the situations that could arise: if he self-harmed, if he asked to go to the toilet, if he got anxious... We also talked about the subject with the students beforehand, so that they were prepared. In no case, however, did we want to make them responsible for the situation. And we wanted them to be clear about that. We knew the theory, but we didn't know if we would be able to put it into practice.

It was also difficult, because she had always been an exemplary student. Before the illness, we never had to tell her what not to do, because she always had fantastic behavior. Now we found ourselves in a situation where we had to say "no" to some things, and it was very difficult for us to do so. For example, during the first weeks at school, she never sat in a chair, she was always standing. Even if we put her in the front row, she always stayed standing, even if it prevented the visibility of her classmates. To tell her to sit, we had to be forceful, because if not, at the very least, she would get up again.

Estela (teacher in the Eating Disorders Unit at Hospital Sant Joan de Déu Barcelona) gave us some advice that has been very useful to us in accompanying her throughout this process, which we use every time we have to tell her something forcefully. She told us that she had two people inside her, one was the person we knew and that we know and the other was her illness. The illness-person ruled the real person. and, although she wanted to do some things with all her strength, such as sitting down, the illness did not let her do it.

Knowing that we were reacting forcefully with the illness and not with it helped us a lot in knowing how to act and having the courage to do so. It seems silly, but for us it has been one of the most important lessons in all of this. Saying "you can't do that" to the illness through her has been our way of helping her so that she too can face it and say no.

Another of the most difficult things for us was knowing what was the best way to support the family."

"Yes, it has been a very, very great personal and professional learning experience. Surely our student has taught us much more than we have taught her. The teachers have also done personal work and it has been a life lesson, accompanied by the family and the professionals."

It has also helped us learn that in supporting these illnesses, despite good intentions, we can often make mistakes. Sometimes, due to ignorance, lack of resources, daring or even prudence, complex situations arise in which you can make a mistake with all good faith. A comment like "wow, you look very pretty" can be a big mistake. And then, what remains is to rectify it and know that next time you will do better, as a great learning experience."

"Personally, I believe that teachers have very little training and information about cases of eating disorders and, in general, mental health. Students spend many hours at school, often many more than at home, and it is important that we are prepared for all these situations."

I think that in the past, school was the space where knowledge was exclusively transmitted; information was only owned by a few people and schools were the place to transfer it to students. Now, information is everywhere, it is on the Internet, in books, etc. And school has another dimension, it is a space to learn, but also a space to motivate, to learn to live together in a community, to work together and understand oneself. And teachers must be prepared for this paradigm shift and have the tools to approach it in the best possible way.

Obviously, we cannot be "professionals in everything", we cannot demand that one person know how to do everything, but that is why the network is very important, linking different environments to learn from each other without exceeding people's capabilities."

"I believe that teachers cannot know everything, but we must be prepared to hear everything and to know, at the very least, what we are being told and show real interest in what we are being told."

It's easy for me to explain this with an example in terms of sexuality. When a student dares to come to a teacher and share some information related to their sexual orientation, for example when they tell us "I think I'm gay", it's important that we first thank them for their trust in telling us something personal, and that the student detects that you normalize what they're telling you and that they feel supported, and that's why it's important that the teacher knows what it means for a person to be gay or show interest in finding out at that moment (if they don't know).

I think it should be the same with mental health. It is essential that we know the different situations that can arise or, if this is not possible because we cannot keep up with everything, that we know which door we can call to receive advice. This would perhaps help to detect cases more quickly and be able to act more quickly to prevent them from becoming complicated."

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"Prevention is always one of the most important tools, especially in mental health. Having information and more knowledge helps to make decisions with more criteria or to be able to help with more integrity and balance. Everyone understands what it is like to break a leg, but there is a great lack of knowledge about mental health. I think this is an obvious fact, and it is not due to a lack of will, but because there are topics that are not very normalized that, fortunately, are gradually becoming normalized."

I believe that this prevention, however, must also be done at home. More prevention is needed in schools, but also more prevention and training in families. School, family and students are a key triangle in education."

"I firmly believe that all these aspects have increased among young people. During childhood and adolescence, a very weak (and at the same time very powerful) time, children and young people are constantly faced with imposed social and image canons, against which it is very difficult to fight (it is also for adults). There are canons that we have established as "good", which do not meet the standards of the majority and which do not always meet the minimum healthy standards. That is why I think that, as adults and, therefore, also as teachers, we must know how to convey to students what is really important and healthy and what is not.

We also have to fight against the information that they have at their disposal very easily and very frequently, such as through social networks (which can sometimes be allies, I'm sure!), and deny what hurts them if it's not true.

I am very much in favor of children and young people being able to make a "free" choice. I believe that making mistakes is a very important form of learning, but the choice must be made with the maximum knowledge to be able to distinguish between truthful information and that which is not. I would never want to paint a room blue if I did not know that blue exists (for better or for worse).

Finally, I believe that we need to help them find the tools so that they can be happier and happier in diversity and we must ensure that health, in all aspects, prevails over everything that is conventional or unhealthy."

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