Long waits for eating disorders treatment during the Covid-19 pandemic are putting lives at risk, a senior medic from the Royal College of Psychiatrists has warned.
Dr Agnes Ayton, chair of the college’s faculty of eating disorders, said families and medical staff are left to shoulder the burden of knowing patients are deteriorating while they wait for an inpatient bed or psychological treatment.
The need for social distancing in dilapidated buildings has meant fewer beds are available, exacerbating a situation that was already poor even before the pandemic, she said.
There are currently 455 adult inpatient beds in the UK for eating disorders and people can face long waits for a space, while some are sent miles from their homes.
“Beds have been reduced in the pandemic due to infection control issues,” Dr Ayton told the PA news agency.
“The vast majority of NHS hospitals, particularly adult services, are all dilapidated buildings and very small rooms.
“During the pandemic, we cannot run to the same level of capacity in hospitals but this means our list of people waiting for a bed has grown.
“The number of people referred for admission with severe eating disorders is a small proportion… but you’re talking about people who are at really high risk of dying or at potential risk of dying.”
Before the pandemic, adult patients in Dr Ayton’s region, which includes Oxfordshire, Buckinghamshire and Berkshire, would wait “three to four weeks depending on urgency for admission, but it’s now more than two months”.
She added: “This is even (in patients) with an extremely low BMI (body mass index), and even with potentially life-threatening conditions.
“That puts an enormous pressure on everyone, so obviously on patients and the family, but also staff, who want to help them.
“It is very, very stressful.”
Dr Ayton said NHS England has committed to investing in community services “but we’re talking about a very slow timescale”.
She added: “We have a large patient population who need help and would benefit from help – there is a sense of urgency on the ground.”
Asked if lives were at risk, she said: “Yes and it’s not just me saying that, colleagues say that and several coroners have said the same thing.”
According to Dr Ayton, the pandemic has led to a rise in people with eating disorders seeking help from charities but there is no official data.
Meanwhile, on the ground, those working in adult services are seeing “an increase in emergency and severity”.
She added: “During the pandemic, there’s a lot of anxiety and a lot of uncertainty, and there has also been uncertainty about food.
“People have been buying things that may last longer. Some of these foods – like pasta or biscuits – can be trigger food for people who are bingeing or who have bulimia.
“Because of the lockdown, people’s social networks and their social support systems have also reduced quite significantly.
“A lot of public health messages have also been about weight loss and exercise during the pandemic and that has been promoted by the Government because of the risk of obesity and serious Covid.
“But if you are a younger person worrying about your weight and shape, you’re bombarded with these messages and think ‘I should lose weight’.”
Psychiatrists have reported seeing patients who do not think they should be helped because others are more deserving in a pandemic.
Meanwhile, other patients who are not high risk may have to wait one or two years for treatment but that “is not a harmless thing”, Dr Ayton said.
“Some people think ‘I’m not sick enough’, or ‘I don’t have a low enough BMI to deserve treatment so I might as well just lose some more weight so that I deserve treatment’,” she said. “We do see that.”
A study led by Dr Ayton covering her region found that one in five patients needing a bed actually end up being treated on a general NHS ward.
The study, which has not yet been peer-reviewed, said: “Owing to the lack of prompt access to specialist eating disorder units, approximately 19% of patients have required acute admission to general hospitals for emergency medical treatment.
“This represents a 20% increase during the pandemic.”
Dr Ayton said that, in this situation, some young people can end up being “treated on paediatric wards for a long period of time, using restraint and nasogastric feeding, when that’s totally the wrong environment for that sort of a really intrusive intervention.
“This wouldn’t happen if there was enough capacity in the system.”
She said these patients should be treated in eating disorders units, where specialist teams integrate nursing, psychology and other therapies.
“These teams help the patient to accept the need for nutrition – they help the patient work towards recovery,” she said.
“Unless you are able to do that, then the patient will perceive any intervention, even if it is life-saving, as coercive.
“It’s a really serious issue and it’s happening up and down the country because I’m hearing that from colleagues in the North West, the South West and the East.
“You put the child, highly distressed, or an adult, highly distressed, on a general ward, and the staff don’t have the experience and the capacity to support them during meal times.”
Dr Ayton wants the NHS to begin counting people with eating disorders properly – how many people suffer, how many need treatment, and how long waiting times are for adults.
“There is discussion about counting long Covid,” she said. “But we need to count eating disorders too.
“NHS England must also work to deliver waiting time targets for adults, otherwise the cruel postcode lottery in their treatment will continue.”
In December, the annual Health Survey for England reported that one in six adults in England in 2019 may have a possible eating disorder – up from 6% in a 2007 adult psychiatric morbidity survey.
Dr Ayton describes the 16% figure as “shocking”, adding: “That’s 10 million people.
“You are talking about a rise over the last 12 years and the pandemic has made this worse, but we don’t have good data on how much worse.”
When it comes to staff training, Dr Ayton also believes much more time must be devoted to this specialist area.
“We know early intervention saves lives, so all frontline healthcare professionals need to be trained in identifying eating disorders,” she said.
An NHS spokesperson said: “The NHS is committed to early intervention for the treatment of eating disorders and has made money available for both early pilots and recurrent funding in all parts of the country from this year for community eating disorder services.
“Local areas are receiving year-on-year increases in their funding for community-based mental health throughout the course of the Long Term Plan and all healthcare providers are expected to work together with other local partners to ensure mental health care for adults, including those with eating disorders is expanded and improved.”
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