A young woman has voiced her horror after being told she was "too fat" to get professional help for her severe eating disorder.
Sammy Halstead, 20, from Caerphilly, said her condition "spiralled out of control" before she went for an assessment with a community mental health team (CMHT) in Cardiff.
But to her horror she was told that she didn't meet the criteria for specialist eating disorder support as her body mass index (BMI) was not low enough.
The psychology student told Wales Live the rejection letter made her think she shouldn't take on more calories.
Sammy has had long-term struggles with food intake and compulsively exercising, as well as self-harming and attempting suicide.
"Reaching out for support – before it spiralled out of control – was difficult enough for me," she said.
"But to then to receive a letter quite simply stating that I was too fat for them to bother helping me made me think I was some kind of fraud.
"The letter haunts me. I think of it every single time I eat a meal, that my BMI is far too high and how I shouldn't consume calories.
"I've read and heard some very invalidating things from professionals, but nothing which had invalidated my struggles surrounding food like this did."
Before moving to Cardiff, Sammy was deemed eligible for specialist eating disorder services by the Caerphilly CMHT.
"I saw my nurse weekly who would offer therapy and support surrounding my issues with food and weight," she said.
"But as my self-harm began to escalate I was discharged from the eating disorder service in the hope I'd get support for the other areas of my mental health.
"However I barely saw my care coordinator and was not offered any beneficial therapy and was lucky to see a psychiatrist on three occasions in over a year."
When she moved to Cardiff last summer she registered with a GP in the hope of being referred to their CMHT.
"I stressed to my GP that I needed crisis intervention, support in place and help regarding my food intake," she said.
"I finally had an assessment which I believed went okay. I was struggling to consume anything more than a small meal and cups of coffee daily.
"I also felt very physically unwell, which is something my BMI wouldn't tell the assessors."
Weeks after being weighed at her GP surgery, a part of the assessment she knew was required, she received a letter by Links Centre CMHT based at Cardiff Royal Infirmary.
It stated that Sammy's BMI was 17.8 which, despite still categorising her as underweight, meant she wasn't eligible for support.
Instead the CMHT recommended she seek support from Cardiff University where she was studying.
"If eating disorder support is based on BMI, then why was I helped and accepted under one eating disorder service for seven months (Gwent), but discharged back to my GP in the other (Cardiff)?
"There are so many inconsistencies from one health board to another, despite them both being so close in proximity."
In response, Cardiff and Vale University Health Board said: "We are sorry to hear that the patient felt that she did not get the support she needed from the mental health team.
“Cardiff and Vale UHB provides mental health services for people with eating disorders which covers the whole range of the body mass index (BMI).
“There are a number of specialist multi-disciplinary teams who provide support and treatment for individuals with eating disorders.
"The team works together to make decisions on individual cases and practitioners use a range of risk factors such as psychiatric co-morbidity as well as physical health and BMI to determine what part of the service is most suitable for the individual.
“If the patient wishes to discuss any aspect of their care further we would ask them to contact our concerns team.”
A campaign, called Dump the Scales , was launched last summer which calls on services to judge eating disorder patients on their mental state, not their physical weight.
It wants governments across the UK to fully implement NICE guidelines through GP and clinical training to ensure those with eating disorders get treatment before they reach crisis point.
Hope Virgo, who spearheaded the campaign, said: "When asked to imagine someone suffering with an eating disorder, most will imagine a stick thin, gaunt looking girl.
"But this is not the reality of eating disorders. People with eating disorders are currently not getting a fair deal in society.
"Despite the guidance, too often individuals are turned away from receiving essential support because they aren’t skinny enough to be considered at risk.
"This leaves the individual feeling like they aren’t worth getting that support, feeling like a 'fake', potentially losing more weight to hit that target and in some cases feeling suicidal.
"This is why I’m calling on governments to review the eating disorder guidance delivered by clinicians.
"The NICE guidelines are right but these are not being uniformly implemented across the nation to the detriment of thousands of people daily. It is time we stopped waiting for people to hit crisis point before offering them support."
In response to the Dump the Scales campaign, a Welsh Government spokesperson said: “To support improvements to eating disorder services, Welsh Government commissioned Dr Jacinta Tan of Swansea University to conduct an independent review of the eating disorders framework for Wales.
"Dr Tan submitted her findings in November and a focused consultation is being planned to inform future actions which will build on the £1.75m we invest annually to improve eating disorder services for adults and children.”
For help regarding an eating disorder, contact the eating disorders Beat on 0808 801 0677 or www.beateatingdisorders.org.uk
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