Psychiatrists say eating disorder patients in the UK face rationing of Eating Disorders care

Seriously ill eating disorder patients who do not respond to treatment are being discharged due to care rationing, the Royal College of Psychiatrists has said.

Patients with extremely low body mass indexes are being excluded from treatment plans in some areas because they are not improving fast enough in the face of increased demand and pressure for services. Admissions for eating disorders have increased by 84% in the past five years.

In recent years, the psychology of eating disorders has recognized a subgroup of anorexia known as severe and persistent eating disorders (Seed). This applies to people who have been feeling very bad for years.

Agnes Ayton, chair of the eating disorders department of the Royal College of Psychiatrists, said many services use the seed concept as a way to ration services, so it backfired.

“They say that if a patient is sick for… three to five years, then the likelihood of recovery is limited, so we should not focus on active treatment. But the evidence base for that is really weak.”

“This is a defeatist attitude and the solution is to invest in more services. But they are releasing patients. It’s a postcode lottery and depends on where you are. Some services would not consider withdrawing care, and certainly not after three or five years.”

She said clinicians talked about Seed in the context of “desperately underfunded” services and thought “we need to ration services and focus on people with potentially good outcomes.”

“But that would be unacceptable for any other disease, such as cancer or diabetes,” Ayton said. “If you have someone with more serious diabetes complications, the health system would not withdraw care, but rather intensify it.”

A parliamentary and health service spokesman for England said last month that urgent action was needed to prevent people from dying from eating disorders, with those affected “failing many times”.

Rob Behrens said the NHS needed a “complete cultural shift” in its approach to the condition and ministers needed to make this a key priority. He said little progress had been made since his office’s report was released in 2017, highlighting “serious shortcomings” in eating disorder services.

Activist and author Hope Virgo said she heard daily from people last year saying their care was “withdrawn because they don’t work hard enough”.

She said: “People left in limbo, left to suffer or left to function. We wouldn’t accept that for physical illnesses, so why isn’t there outrage that this has happened for eating disorders.”

One patient said he was told they had “one more chance to recover” and was referred for a six-week course of therapy. They said, “When I argued why it was unachievable, I was ignored and was deemed unwilling to recover.”

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Daiva Barzdaitiene, a psychiatrist, recently caused controversy by publishing a letter saying that treatment for eating disorders should be “voluntary in most cases”. She said that if the disorder lasts for more than five years, “only people who ask for help should be treated in eating disorder facilities.”

Ayton said such extreme beliefs were rare, but they did occur and did not take into account the impact that malnutrition can have on the brain and one’s ability to function rationally.

“This justification ignores the harms of malnutrition because when you are severely malnourished your insight is impaired,” she said.

Ayton said there was a lot of pressure on trusts to discharge patients who were not committed because it affected their performance rates. “There is pressure and we should learn from diabetes colleagues who accept that some people need lifelong support, not pressure to be discharged.”

An NHS spokesperson said: “While the pandemic has taken a huge toll on many people’s mental health, improving care for people with eating disorders is essential as the NHS treats 55% more young people for eating disorders than before the pandemic. and the introduction of rapid early intervention for eating disorders for people aged 16-25.

“Next year, the NHS will invest around £1bn in adult community mental health services which will expand and improve these services and help connect with local GPs to help more people get the care they need.”

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