Wednesday, 3 June 2015

Increasing hospital admissions for eating disorders


- Nicola Byrom, @nicolabyrom
This morning I work up to news that made my heart sink. The BBC report that in the last 3 years the number of hospital admissions for young people with eating disorders has nearly doubled. This means that the prevalence of eating disorders must be on the increase. The BBC is dutifully asking whether social media, the curse of our generation, is to blame. The pressure from the online world to be fit and healthy must be getting to young people. I don’t doubt that it is. And we still haven’t worked out how to teach young people to be confident about their bodies – though there has been some fantastic work by @NatashaDevonSET and www.bodygossip.org. But, though eating disorders feed off of a desire to be fit and healthy, they are rooted in much deeper set of insecurities: uncertainty about life, low self-esteem, and stress. 

We need to ask about the increasing pressure that we are putting young people under. As @AnthonySeldon voiced in March – exam pressure today is putting children under “vile, cruel pressure” .

I'm very worried about the possible increase in prevalence of eating disorders among young people. It's a horrific illness, devastating to the sufferer, their friends and their family. However, the dramatic increase in hospital admissions for eating disorders raises concerns about how we are treating eating disorders. Hospital admission for mental distress in young people should be an absolute last resort. We should never have to get to the point where a young person needs to be admitted to hospital. At times of great emotional and mental distress people need safety and security. They need to trust the world around them. Except in the rarest of circumstance, this is best provided by the home environment. 

I was diagnosed with anorexia about 15 years ago. As I became increasingly unwell, I withdrew and shut out the world around me. To recover, I had to start opening the doors again and engaging in real life and the world around. As we put young people in hospital we remove them from the friends and family who they trust and can ultimately keep them safe and well. We remove young people from the world they need to engage with to recover. We need to be able to treat the mental distress of young people at home. We need to support friends and family to support young people to remain at home. We need better and more intensive early intervention. 

Hospitalisation is devastating for friends and family who care. The separation is painful. The distance for family can be unbearable. A few years ago someone very close to me was admitted to general hospital. She had Anorexia Nervosa. Her condition had deteriorated to a stage where her body was no longer functioning properly. Physically, her health was too unstable to allow her to be admitted to a mental health unit. So, in deep mental distress she remained for weeks on a general hospital ward, which was more familiar with caring for elderly individuals. This place might have had the equipment to monitor her physical health, but it was not a positive place for her to be. 

In our time of “economising the NHS,” we must ask why we are not investing in early intervention. Supporting young people at home is more economical than keeping someone in a general hospital bed for weeks. That's before you even begin to factor in the cost to that person’s mental wellbeing. Our team at Student Minds summarised some of the financial arguments for better and more joined up early intervention for eating disorders in our University Challenge Report.

So, what is currently stopping early intervention? I don’t have a complete answer. However, in anecdotal reports, I still get the impression, far too often, that the experts that we turn to for eating disorder interventions are still struggling to work out how to help. From counsellors to GPs, I still hear too much focus on food and eating. This has got to change. 

Yes, to recover from an eating disorder you have to normalise eating patterns. You may have to gain weight. But for most, the disrupted eating patterns are a solution to the problem. Behind the disrupted eating patterns, there are many psychological challenges that need to be addressed. 

Through years of work, the Institute of Psychiatry and Maudsley have mapped out a psychological intervention for eating disorders that focuses on understanding the costs and benefits of the psychological traits that maintain eating disorders. This approach looks to build motivation for recovery, encouraging young people to develop their own drive to recover. This understanding, this focus on psychology, urgently needs to be disseminated nationally. Early intervention that young people can engage with rather than be afraid of, exist and should be common place. 

To learn more about the ideas discussed here, see:

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