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Eating disorders: Hundreds more die as funding crisis deepens [1]
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Date: 2023-07
More than 250 people have died from eating disorders since the government pledged to improve services six years ago, openDemocracy can reveal.
The data, from the Office for National Statistics, shows 94 people died from eating disorders in 2021 alone, the latest year with available statistics. Deaths are highest among women aged between 40 and 50, but six teenagers have died since 2018. A string of avoidable deaths in the years before 2017 saw the Parliamentary and Health Service Ombudsman urge the government to clean up its act, but the ombudsman warned in February this year that little progress had been made.
Eating disorder services remain desperately stretched, with no new beds for adults since 2017 despite soaring demand. The situation is so bad that nurses on general wards are having to turn to security guards to help them restrain patients, which can be traumatising.
One adult patient told openDemocracy the waiting time for her to see a therapist was over a year and that she had been advised to watch Instagram videos instead.
Amy*, who did not wish to give her real name, was hospitalised multiple times between the ages of 15 and 19 because of a severe eating disorder. She said that on several occasions nurses needed to call in security guards to pin her down so they could insert a tube through her nose in order to feed her because they could find no other trained staff to do so.
While Amy, now 23, believes the intervention itself was necessary given her level of malnourishment and refusal to eat, she found the use of security guards disturbing.
“They tend to turn up in the middle of chaos, and it’s just this strange person who is, generally, fairly large and bulky and kind of intimidating,” she said.
“Medical staff try to do what they can to de-escalate while they are restraining you, whereas the security guards don’t tend to do that – they come in and talk over your head.”
After Amy recovered enough to be discharged, she found adult eating disorder services provided far less support than children’s services.
“The service I was with until recently could only offer Zoom meetings in a group of 20 people or Instagram Live videos, unless you were critically ill and needed to be in hospital because they just simply didn’t have funding,” she said.
“Being told things like ‘you’re not sick enough’ can lead to people with eating disorders spiralling.”
Hannah*, who is 17 and also asked us not to use her real name, told openDemocracy it had taken her years to deal with the trauma of being restrained as a patient.
Between the ages of 12 and 14, Hannah was a patient at West Lane Hospital in Middlesbrough where she said physical restraints were often used before staff had even attempted to calm patients.
Hannah said her autism made being restrained particularly difficult for her, but the mental health unit did not take this into account.
West Lane Hospital closed in 2020 after three teenagers took their own lives in an eight-month period up to February 2020 while under the trust’s care. An independent inquiry found that the mental health unit was “chaotic and unsafe” and that use of restraint was “excessive and inappropriate”.
openDemocracy spoke with eating disorder specialists who acknowledged that restraints were unpleasant, but said they were a last resort to save lives.
“Of course, it’s horrendous for families, for parents, for young people and even for the staff,” said Sarah Fuller, the clinical lead dietitian with Northamptonshire's Children and Young People Mental Health Service. “But what it does is it saves people’s lives so that they can get to treatment.”
Latest available figures show there were on average just 400 beds in eating disorders units for adults in 2021 – the number has not risen since 2017. There were 238 beds for children in June, only 22 more than there were in 2016.
While the number of beds has remained flat, admissions have been growing year after year with a noticeable jump after the pandemic. Last year, there were 28,436 hospital admissions for eating disorders in England, up from 20,650 (a 38% increase) the year before the pandemic. During this period, there was an 82% increase in the number of children being admitted to hospital (from 4,232 to 7,719).
Clinicians told openDemocracy the lack of specialist staff was also a problem because better treatment in the community could prevent people from ending up in hospital.
There were just 61 full-time psychiatrists specialising in eating disorders in the UK in 2021, according to a workforce survey of both the NHS and private sector carried out by the Royal College of Psychiatrists. More than a dozen full-time posts were unfilled.
Hope Virgo, an eating disorder campaigner who herself was hospitalised with an eating disorder as a teenager, believes that inadequate resources may have contributed to some patients being unnecessarily restrained.
“I think [the use of restraint] is completely inhumane,” she said. “If we are using it, we should be asking what it is about the treatment that’s not encouraging that person to start to eat and start to get well.”
Clinicians told openDemocracy that more research was needed to determine whether restraints are being used unnecessarily.
Agnes Ayton, chair of the Royal College of Psychiatrists’ eating disorders faculty, said: “There isn’t enough capacity to place everyone in an eating disorder specialist unit, even though that is what medical emergency guidance recommends, so they end up in large numbers in acute hospital wards.
“Here nursing staff and even doctors have very limited training on how to treat eating disorders and that could result in increased use of restraints.”
One nurse who preferred to stay anonymous told openDemocracy that she believed restraints had become overused in her ward because “we were not treating the underlying trauma of each individual, just trying to ‘fix’ the immediate issue of weight gain and BMI”.
Ayton takes the view that feeding patients under restraint can save lives, but with proper training staff can manage eating disorders patients’ anxieties without resorting to it.
“There are very well established psychological techniques that can help patients feel less anxious and reduce the need for using restraints,” she said. “But there needs to be a lot better training for non-specialist staff to be able to do this given the majority of the patients get admitted to non-specialist units.”
Despite the Royal College of Psychiatrists updating its guidelines last year, Ayton said that implementing them has been slow, which she puts down to a lack of funding.
“We are desperately underfunded, which is having a massive impact on patients’ lives and also on staff.”
Kate Parminter, a Liberal Democrat peer who sits on the All-Party Parliamentary Group (APPG) on Eating Disorders, told openDemocracy that “my sense is that [eating disorder services] are not a political priority for this government”.
“They recognise the scale of the problem,” she said, “but they aren’t putting in the resources because it’s going to cost significant amounts of money.”
The government says it has increased funding every year, but campaigners said it has not been enough when demand is surging.
“They can say they’re putting in more money but there is no way of knowing if that is sufficient without them carrying out a prevalence study, which they are refusing to do,” said Parminter.
“And we know from evidence that people are having to wait an extremely long time for care in the community and there aren’t enough beds for severe cases.”
The eating disorder charity Beat has estimated that there are one and a quarter million people in the UK with some form of eating disorder. Among mental health problems, eating disorders have the highest mortality rate.
In June, the government said that it was investing £1bn in improving community mental health care for adults with severe mental illness, including eating disorders. It added that it was “expanding the number of trainees and skilled professionals” who provide care for people with eating disorders.
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https://www.opendemocracy.net/en/eating-disorders-restrained-security-guards-deaths-government-funding-crisis/
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