Investment in adult eating disorder services has failed to keep up with spending on care for children with conditions like anorexia and bulimia, creating an “unacceptable health inequality”, a report by the Royal College of Psychiatrists says today.
Since 2016, around £135million[i] has been invested in children and young people’s eating disorder services, with around 70 community teams now deployed across the country. Access to treatment has improved.
Eating disorders, such as anorexia and bulimia, can have a devastating impact on people’s lives but getting help early has been shown to improve recovery rates. Without it, recovery can take years or even decades.
The College is calling for the focus brought to bear on children getting professional help early to be replicated in services for young adults aged 18-30.
Referring to the funding disparity, the report, called ‘Early Intervention for Eating Disorders’, says: “This situation creates an unacceptable health inequality, whereby patients from the same geographical area if they are under age 18 can self-refer to Community Eating Disorder Service for Children and Young People (CEDS-CYP) and are seen and treated rapidly.
“In contrast, if they are age 18 or above, they may be faced with multiple gate-keeping hurdles before accessing Adult Eating Disorder Services (AEDS), causing substantial delays to their treatment.”
It is calling for substantial investment in adult services so over-18s presenting with an eating disorder for the first time are given rapid access to treatment.
Dr Dasha Nicholls, chair of the College’s eating disorders faculty, said: “The parliamentary ombudsman’s report into the tragic death of 19-year-old Averil Hart revealed some appalling failings in mental health services which must be addressed.
“While a lot of work has been done to try to tackle these issues, it has yet to impact services directly.
“The NHS Long Term Plan promises to improve support in the community for adults with serious mental illnesses.
“What we now need is for the Government to spell out exactly how those improvements are going to be delivered for adults suffering from eating disorders.
“We need parity between child and adult eating disorder services to ensure everyone has the best chance of recovery and no one needlessly loses their life.”
The report found that people can wait up to 41 months for treatment, with adults waiting on average 30% longer than under-18s.
Adults must also overcome hurdles before accessing services, such as their Body Mass Index (BMI) being more than 16 or if they are self-harming or misusing alcohol. This can cause major delays to their treatment.
This means many over-18s are waiting more than three years for treatment, after which time recovery outcomes are poorer as the eating disorder is established.
The delays are putting lives at risk as people with an eating disorder are twice as likely to die than the general population. Risks of psychological illnesses – including suicidality – are also high from the early stages of an eating disorder.
James Downs, who had to wait more than six years for treatment, said: “I first became unwell in my teens but did not get the help I needed as children’s services were not as good as they are now.
“But when I went to adult services I was told I was too unwell for treatment as my BMI was so low and was refused CBT.
“I ended up having to drop out of medical school and tried to take my own life by overdosing.
“Life could have been so much different had I been offered the support I needed when I sought help as an adult.”
A very different picture is emerging for young people. Latest NHS data shows 81% of under-18s received treatment within one week of an urgent referral, while 87% of non-urgent referrals were seen within four weeks[ii]. These percentages have steadily improved since investment and monitoring began in 2016. Early interventions have been shown to improve recovery rates.
The College’s report calls for parity between child and adult services in terms of access, waiting times and service provision – a recommendation that was made in the Parliamentary Health Ombudsman’s 2017 Report into the death of 19-year-old Averil Hart from anorexia[iii].
Notes to editors
1. The Royal College of Psychiatrists’ Eating Disorders Faculty position statement: Early Intervention for Eating Disorders is available here: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/position-statements/ps03_19.pdf?sfvrsn=b1283556_2
2. NHS England do not collect data for adult eating disorder services.
[iii] The Parliamentary and Health Service Ombudsman report: Ignoring the alarms: How NHS eating disorder services are failing patients is available here: https://www.ombudsman.org.uk/sites/default/files/page/ACCESSIBILE%20PDF%20-%20Anorexia%20Report.pdf