In the early 'nineties Edinburgh's Eating Disorders Service at the Cullen Centre hosted a series of conferences on eating disorders. Delegates from Scotland and the North of England expressed an interest in meeting up regularly and forming a longer-term alliance. Consultant psychiatrist Alex Yellowlees suggested his own hospital, the Perth Murray Royal, as a comfortable and convenient venue within 2 hours travelling from most parts of Scotland. In October 1993 the Scottish Eating Disorders Interest Group (SEDIG) was formed - made up of NHS and private professionals and enthusiasts from voluntary and self-help groups from all over the country. Eight years later, SEDIG continues to flourish, with a diverse mix of members who produce their own distinctive style of meeting, still in the spectacular Murray Royal ballroom.

Membership
Membership of SEDIG is open to anyone with an interest in eating disorders, with an emphasis on a mix of professional and self-help participation. Most areas of Scotland are represented, and we have also welcomed members from Northern Ireland and the North of England. Members include general practitioners, psychiatrists, psychologists, nurses, dieticians, art therapists, NHS and private therapists, school counsellors, former sufferers, members and leaders of support groups, mothers and other carers of people with eating disorders - men and women - representatives of both NHS and private and voluntary sectors. No one is denied membership. Until the end of the century professionals from Child and Adolescent Psychiatry were under-represented, but this changed in 1999, a year when SEDIG meetings focussed on Eating Disorders and the Family.

Aims of SEDIG
One important function for the group was to link members into a much-needed network for care for people with eating disorders. In 1993 NHS eating disorder services were patchy and variable. Sadly, this remains true in the new millennium. There are still no dedicated NHS inpatient facilities for eating disorders patients in Scotland. Edinburgh and Aberdeen have multidisciplinary specialist outpatient services. Elsewhere in Scotland professionals with an interest in eating disorders work in relative isolation within acute general psychiatric services. Adolescents may be better served than adults, since eating disorder services and inpatient beds receive higher priority in specialist child and adolescent units.

Meanwhile the private and voluntary sectors appear similarly haphazard, isolated and unlinked, depending on the enthusiasm of key individuals and on finances. Fostering links might facilitate mutual awareness, support, advice and cross referral.

SEDIG also aimed to set up a regular forum for discussion of current issues, recent developments and difficult cases, and to promote learning of new skills, development of audit and collaborative research.

These aims have been broadly met, by means of twice yearly all-day meetings. In addition the group has established links with the Norwich-based Eating Disorders Association (which sends representatives to committee meetings as well as all-day meetings in Perth), and with the Eating Disorders Special Interest Group (EDSIG) of the Royal College of Psychiatrists (via medical members of SEDIG).

The Committee and the Chair
Each of our one-day meetings incorporates a decision-making business meeting after lunch, and this is open to all. A committee of about a dozen people gathers an extra couple of times a year, to put ideas into practice and finalise arrangements. The committee could be democratically elected if there were any competition for places! In fact it relies on volunteers and those who have "volunteering" thrust upon them.

The committee is a mix of professionals and self-help representatives. Harry Miller, head of the eating disorders service in Aberdeen, chaired the group for the first five years, succeeded by Chris Freeman of the Cullen Centre, then more recently, by Maggie Gray. It is perhaps a sign of the maturity and confidence of the group that we have managed to elect a Chair who is neither male nor a medic. Maggie is a nurse psychotherapist whose practice spans NHS and private practice, who is involved in both clinical work and training and supervision all over Scotland, and was herself a founder member of SEDIG.

Funding and Finances
SEDIG now charges £10 per year for membership (£5 for non-professionals), covering attendance and coffee at all meetings. Even this low fee is waived for anyone in financial hardship. Despite the low charge, SEDIG gradually accumulated a surplus for some years. This was partly as a result of using our own "in-house" speakers for conferences, and because the family of Julie Arnott, who had an eating disorder, generously gave SEDIG a sum of money in her memory. This fund has stimulated the group to examine worthwhile uses for our surplus. One experiment has been to offer financial support to a struggling self-help group, another to invite an outside speaker, Ivan Eisler, to lead a workshop.

An early attempt to produce a newsletter failed after two issues, but with turn-of-the-century word-processing and an enthusiastic secretary, our newsletter runs to two editions each year and is now launched on the web.

Meetings
Twice yearly conferences are held, with attendances reaching 50-60 people. Typical meetings kick off with an overview of the day's topic, followed by group workshops and discussion. The format ranges from didactic lectures and staged debates to interactive workshops and discussion of difficult issues. Formal work is punctuated by time for networking, and the post-prandial business meeting. The day ends with a plenary session including feedback from groups. Evaluation forms have shown a high level of satisfaction with both form and content of meetings.

Topics have included self-esteem, cognitive behavioural therapy, non-talking therapies (such as art therapy, physiotherapy, reflexology), body image, the role of the dietician, binge eating disorder, compulsory treatment, preventative strategies, in-patient facilities and the needs of carers. Whole sessions have been devoted to research updates and presentations, and ongoing work by SEDIG members is publicised at business meetings. There is no formal SEDIG research group, but service audits, surveys and other investigations have been fostered and fed back to SEDIG. We have not used SEDIG finances to fund research, aware that other resources are available for this purpose.

Important Issues
The participatory, democratic style of SEDIG is reflected in the way meetings are structured. The growing familiarity of the beautiful venue, the relatively small size of the meetings and tendency to see the same faces time after time produces an informality and even intimacy of atmosphere. The mixture of professional helpers and self-help group members, ex-patients and their families generates a creative tension which helps break down personal distancing. In some workshops there may be a risk of painful self-disclosure which could be difficult to manage appropriately outside a therapeutic setting. Indeed participants may be - or have been - in a therapist-patient relationship outside SEDIG meetings. Issues of confidentiality become particularly important where different members adhere to different codes of practice.

The atmosphere of SEDIG meetings still benefit from the trust and mutual respect of its founder members. There is tolerance and acceptance, a lack of political agenda - it did not arise as a pressure group - and a tradition of courtesy and friendship.

Into the new Millennium
SEDIG enters the 21st century with a woman president, a growing membership and the benefits of new technology. The group has evolved slowly to preserve its balance, and continues to evolve. SEDIG has potential as a growing resource, possibly achieving a more public profile, for instance providing advice to the new Scottish Parliament and consultation about the reforms to the mental health act. We remain a focus, a network, a specialist advisory body, a provider of training and shared expertise (and sometimes acknowledged ignorance), a watchdog, a unique alliance, and hopefully a model for co-operative health care bodies in the future.

Harry Miller & Jane Morris