In this guest blog to mark Eating Disorders Awareness Week, Michael Chawatama discusses the need to reach out to those with eating disorders more quickly.
About 1.6 million people suffer from an eating disorder in the UK, which equates to one person in every 39. Anorexia has the highest mortality rate of any psychiatric illness and it has been estimated that 15-20% of sufferers will die prematurely from either complications or suicide. A new study by King’s College London and University College London’s Institute of Child Health highlighted how eating disorders have increased by 15% since 2000, and latest figures show that hospital admissions have gone up 8% in the past year alone.
Now, in Eating Disorders Awareness Week 2014, we are reminded that there has never been a more urgent time to assess how we reach out to people living with an eating disorder. The reality is that many people are not getting the help they desperately need due, in part, to the strict guidelines which are used to diagnose eating disorders.
For example, in order to be diagnosed with anorexia, a person must have a body weight that is at least 15% below the expected BMI. They must also exhibit a distorted view of their body and demonstrate a fear of ‘fatness’. Until recently, a criterion was in place that required an individual to present amenorrhoea – the absence of at least three menstrual cycles – in order to diagnose them with anorexia. This was finally removed after it was found that some individuals exhibit all other symptoms and signs of anorexia, but still report some menstrual activity.
While these criteria are intended to help clinicians accurately diagnose eating disorders, in reality it means many sufferers are being denied help at the critically important early stage, allowing a bad situation to worsen before intervention.
At Cygnet Hospital Ealing, we treat a range of eating disorders, including anorexia and bulimia nervosa, binge eating disorder, body dysmorphic disorder and eating disorders not otherwise specified. Our service users are often severely unwell, and have complex needs. We are one of the few providers able to treat people with BMIs as low as 10, and are able to specialise and work with people on naso-gastric feeding regimes, something which not all units are equipped for, or willing to undertake.
Our aim is to create tailored pathways to help service users on their way to recovery, so they can reclaim the quality of life they deserve once they leave our care. As such we have an agreement with our local GP to have all our service users registered with them upon admission, allowing for better continuity in all aspects of their care. This is particularly helpful for service users who come from hundreds of miles away.
We also have the specialisms to deal with the most severe cases of eating disorders. But it is imperative that the medical community looks at how people with eating disorders are being dealt with in the first instance. The current status quo, where individuals are being told to come back to their GP in a few weeks or months because they are not considered severe enough only runs the risk of allowing the person to slip further into the grip of an eating disorder. Fundamentally, we need to see an increase in primary intervention to help prevent long-term inpatient admission. For those on the frontline, it needs to be less of a tick-box exercise, with diagnoses being given on a case-by-case basis.
There is also room for improvement in post-discharge services. We would like to see community teams do more to engage with people under their care upon inpatient admission, and then work with the inpatient team for the duration of any admission. This will help ensure there is a clear discharge pathway and clarity for all parties concerned with how to manage within the community and what the protective factors are; all of which will, in turn, help reduce the chances of a relapse.
We all have a responsibility as clinicians to ensure that disorders are better understood and that people are able to access the treatment and support they need in a timely manner. With the prevalence of eating disorders continuing to rise year-on-year, we now need to look at how best to reform our practices to address the growing demands for support. The benefits would be immeasurable, in terms of cost savings and reduced relapses and re-admissions but, more importantly, in lives saved and enhanced. We all have a duty to play our part, and that is why I am supporting Eating Disorders Awareness Week.
Michael Chawatama is clinical services manager at Cygnet Hospital Ealing, one of five eating disorder service providers in the country to be accredited ‘excellent’ by the Royal College of Psychiatrists.