The rise in hospital admissions for people with eating disorders reported on Thursday is very concerning. It shows that much more must be done to intervene early and provide intensive support in the community.
One of the main problems patients face is that for many, their eating disorders are simply not taken seriously enough. Eating disorders are complex mental illnesses with the potential to be incredibly damaging. They are not a diet gone wrong in fact, anorexia nervosa has the highest mortality rate of any mental illness. They often cause major physical health problems and without the right support people with eating disorders often become isolated: cut off from education, work or a social life.
NHS data shows that hospital admissions for those with eating disorders increased from about 14,000 in 2016-17 to just over 19,000 in 2018-19. This in itself is very worrying hospital admission is typically reserved for the most severely ill patients, which suggests that too often, people with eating disorders are not being identified and supported to access help until they have reached crisis point. Guidelines from Nice recommend that, where possible, outpatient treatment should be offered in the first instance. Getting rapid access to high-quality treatment and support in the community can prevent people with eating disorders from deteriorating to a point where hospital admission is required and provides the best chance of recovery.
Some are quick to blame social media or celebrities, but this is too simplistic. There is a lot to learn about what causes eating disorders, mainly because research in this area has been woefully underfunded. But recent advances in the study of genetics suggest that some people are likely to be at a much greater risk of developing an eating disorder when exposed to various life experiences such as stress, bullying or traumatic events. More research will be key if we are to achieve the ultimate aim of preventing eating disorders from developing in the first place.
But what needs to be done to ensure that everyone with an eating disorder gets the help they need? Since 2016 there has been a big step forward in access to specialist NHS treatment for under-18s in England. This progress was driven by the introduction of an ambitious national standard that evidence-based treatment should start within four weeks and additional investment, staff recruitment and training. However, we know that this progress has not been even, with some areas being left behind. The government and the NHS in England must ensure that the additional funding that they have pledged for these services in the NHS Long Term Plan reaches the front line, and that national standards are met in every area.
Adult eating disorder services are severely underresourced, having been overlooked in the preceding NHS mental health strategy. In 2017 the parliamentary and health service ombudsman published a damning report that highlighted the need for greater investment in these services to prevent further lives being lost. Beats recent research illustrated how adults with eating disorders in England face a postcode lottery to access specialist treatment. We now need to see the government and the NHS apply the same level of ambition for adult eating disorder services as they have for under-18s. This would mean introducing a fully funded access and waiting time standard for adult eating disorder services.
We also need more innovation in care. In much of the country if you do not meet the thresholds to access an inpatient bed, but you need more support than outpatient care, there is nothing available. Intensive day care or home-based treatments can minimise the need for inpatient admissions, reduce length of stay and provide a step down from inpatient care to living back in the community.
Investing in specialist services is crucial but will not be enough on its own. On average it takes three years before seeking help. We need a more comprehensive effort to reduce this gap. Too often an eating disorder is only suspected when the individual has already reached crisis point. GPs, hospital doctors, nurses, education staff, employers and others, if properly trained, are well-placed to spot the early signs of an eating disorder and to support referral to a specialist.
On average UK medical schools provide less than two hours teaching about eating disorders, with one in five providing no teaching at all. Opportunities for junior doctors to benefit from clinical experience are extremely limited. The General Medical Council (GMC), which sets standards for medical training, has committed to work with medical schools and others to ensure that tomorrows doctors are properly trained in how to identify, safely manage and refer patients with eating disorders. In 2019 the GMC acknowledged the need for medical training in this area to improve and took some encouraging steps. We hope that we can support this work further in 2020.
If you are worried about yourself or someone else you can call Beats helpline on 0808 801 0677 12pm 8pm on weekdays and 4pm-8pm on weekends.
Tom Quinn is director of external affairs at Beat, the UKs eating disorder charity
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Anorexia is the deadliest mental illness. Why is the NHS still not taking it seriously? - The Guardian
