Meeting the challenge of eating disorders

New figures analysed by the Royal College of Psychiatrists have revealed a ‘postcode lottery’ in how quickly those aged under 19 receive urgent care for eating disorders across England. Figures show an improvement in the number of young people being seen within one week, but while in London more than 84 per cent of people are seen within this time, in the north of England the figure is just below 68 per cent.

Although the NHS in England has seen overall improvements in waiting times for appointments, Dr Emily David, Lead Clinical Psychologist, Specialist Eating Disorder Service, Hampshire CAMHS, said: ‘At the moment there’s quite a disparity between what eating-disorder service provision looks like up and down the country. There is a vision there will be a certain standard of care where a young person can present, wherever they are, and expect a certain quality and level of service within set time frames.’

The Guardian also recently reported NHS Digital figures that showed hospital admissions of those with an eating disorder as a primary or secondary diagnosis reached 13,885 in the year up to April 2017, compared with 7260 in 2010/2011.

David said at her service she has seen an increase in young people coming for help when they are more acutely unwell. ‘The trend is that young people are presenting later and coming through more acutely unwell right from the outset. They’re not always able to be held safely in the community and require not just a psychiatric admission, but also admission to paediatric wards for medical stabilisation prior to a community package of care being put in place or then transferred to the paediatric psychiatric ward.’

The government is funding eating-disorder community teams in England over the course of the mental health five-year forward view plan, which ends in 2021. These groups, funded by £30 million per year, were set up in 2017 with an aim to provide community eating-disorder services across the whole of the country.

David hopes new community teams will mean fewer hospital admissions and more-timely specialist treatment. ‘Community teams can’t hold all risk… they’re not emergency services. Some of these new services are really embryonic in terms of being set up and resourced and being able to deliver the NICE-recommended treatment package for young people. While the intention is there, the rollout of these services, their reach, accessibility and functioning still needs a lot of development.’

David pointed to research by the eating-disorder charity Beat that showed 34 per cent of people were unable to name a single symptom of an eating disorder. This lack of awareness, she said, could be contributing to young people seeking help far later, and a general misunderstanding of the severity and dangers associated with eating disorders. ‘I think that eating disorders can be more difficult to identify in young people as it’s often a secretive illness. I think young people aren’t necessarily willing to identify that they’re experiencing a difficulty, so asking for help as a young person is incredibly difficult. There are questions around being taken seriously… I hear people saying all the time that it’s just a phase or a growth spurt or stress. It’s really easy to not pick up on the severity of something that’s really critical and acute.’

In response to these challenges David and her colleagues have launched a county-wide campaign in Hampshire – the Everybody Campaign – to raise awareness of eating-disorder symptoms and open up conversations among young people about body image. Children in the county’s primary and secondary schools will be offered free body-image workshops, and GPs surgeries and school nurses have been provided with information on eating-disorder risk indicators. In October two day-long events are being held for children and young people to learn more about eating disorders, as well as a professional conference providing practical information and strategies for frontline professionals to feel more confident in identifying and supporting young people with eating difficulties.

David explained: ‘The Everybody Campaign is targeting eating disorders, body image and self-esteem in young people. We’re doing huge projects around prevention and early identification aiming it at young people, parents, carers, schools and GPs. I think some services are trying to be really proactive in recognising that these young people are coming through too late and we need to be aiming for early identification.’

Early identification plays a key role in eating disorders, with earlier diagnosis and specialist treatment leading to much better outcomes. ‘We need better links with GPs and schools who are so well placed to do that early identification and getting people help early on. One of the things I see is just how late people are presenting, and often GPs or nurses have been monitoring and waiting for six months to a year but that allows an eating disorder to become very entrenched. But if they had referred straight away, which NICE and Beat recommends, the prognosis is much, much better.’

This area of clinical work also presents many other challenges – David pointed to transitions between CAMHS and adult services as an area of concern. She said moving from child services after the age of 18 presents young people with a real culture shock at times. While NICE guidelines suggest family therapy as the therapeutic approach in helping young people with eating disorders, adult services focus more on the individual. ‘We are working with our adult colleagues to see if we can help to bridge that gap. One of the things we’re trying to do in CAMHS services is try to model, a little bit more, how adult services work in the run-up to transition. It’s a really big shift for families too – they’re used to having a family-based model where they’re in every therapy session and are fully involved with that person’s care plan. Then suddenly when someone moves to adult services, if the young person doesn’t consent, they have no information being shared with them whatsoever.’ 

- For more information on the Everybody Campaign and to access its resources see https://hampshirecamhs.nhs.uk/campaigns/everybody-campaign