The All-Party Parliamentary report on the eating disorder emergency, did we miss a trick?
The All- Party Parliamentary report on eating disorders has described the current situation with incidence as an eating disorder emergency. This seems to be confirmed by information published in the Times today about the huge rise in the number of young people self-harming, of which part of this is “eating disorders” (whatever that means). How many people talk about eating disorders when they mean Anorexia?
This report brings to the surface many people with lived experience, to share their frustration and disappointment with the treatment they have received or the lack of it. Access to treatment is like a funnel with a lot of people at the bottom with different kinds of eating disorder needing specialised help, treatment availability at the top being inadequate. And this has to do with the fact that eating disorder treatment for each individual requires multi-agency specialised help; dietary help, family systems therapy, specialised nursing, trained clinical psychologists (not just any old psychologist), medical input and specialised psychiatry for people with an eating disorder plus another mental health condition such as obsessive-compulsive disorder or autism. These people have to work as a team for each patient who is ill enough to need service provision.
Gosh that’s a big ask. There were never enough psychologists available to meet community needs for any mental health problem and there never will be. It’s a huge cost per patient.
Even if service provision were perfect, including dedicated hospital beds (000s), treatment is complicated by denial, secrecy and resistance on the part of patients – at least those with anorexia. I understand this perfectly; this fear of giving up control, of getting fat, of all the benefits that an eating disorder provides such as being your only friend and Guardian Angel. It is this that stops people in the early stages from talking to people. And even if they do talk, the people they talk to are not trained in the language that will help a person reconsider what they’re doing or feeling.
Even if they are in treatment, relapse and resistance are common when our patients bargain with treatment providers to ensure that progress is not really happening. Example, I will eat to get out of hospital so that I can be free to continue with my exercise and diet. It just makes anorexia in particular one of the most difficult mental health problems to treat, and the costliest to the public purse.
It would seem that all the awareness programmes we have done over the past 3 decades has done nothing to stem the increase in eating disorder cases, so why should we think more of the same will make any difference? The main issues here are prevention, early identification and treatment.
Re prevention; it’s not achieved by going into schools and talking about eating disorders which can actually make things worse. Preventing eating disorders is a huge subject because in some people there is a genetic element. Teaching emotional resilience with a wide emotional vocabulary from a very early age is known to be highly protective. End of story.
As for early identification. It’s good that parents and schools should be aware of some worrying signs and can signpost children to appropriate and effective help with parents and schools on board. But it is hard to distinguish some normal behaviours in young people from behaviour that is more worrying. With 4 decades of work in this field, I know that the signs of anorexia are often present well before someone has embarked on a fitness, health or weight-loss programme that precedes the illness. Anorexia, in particular, is like a demon that lurks from birth, waiting for something to trigger it into life. The other problem with early identification is how few people know how to get inside the “I’m alright, leave me alone” that is a feature of anorexia. Exposing children to eating disorder material as part of PHSE doesn’t help with that.
Treatment; the Parliamentary Report rightly flagged up the lack of appropriate treatment, but I already explained the difficulties. I’ve considered over many years whether throwing more money at treatment services would solve the problem or make a dent in it and – I don’t know. Despite millions of £/ $ thrown into eating disorder research, we have some useful things to do, and better awareness; there is still no known treatment for anorexia that promises success. But there are good workable treatments for bulimia nervosa and compulsive eating that no one talks about.
As someone said on BBC today, many people just get sick and tired of being sick and tired. But many stay imprisoned because it’s the only life they know. This may mean that “some people are sent home to die” as stated in the report. I feel bad that this is an accusation thrown at well-meaning health professionals. There is, or should be, permission to stop treatment if it is not working, and to substitute it with palliative care and not to paint all treatment providers with the accusation of being uncaring.
Eating Disorders will always raise strong feelings and we need activists and experts contributing to the debate. I just wish that the All-Party Parliamentary Group had come up with concrete proposals for change that are properly examined, such was attempted with the Obesity Foresight report. Where does the problem lie, in the money available, or in the society we have created?
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