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Eating disorder services: starved of resources

Published online by Cambridge University Press:  02 January 2018

Ulrike Schmidt*
Affiliation:
Eating Disorder Unit, South London & Maudsley NHS Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ
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Abstract

Type
Editorials
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 2001. The Royal College of Psychiatrists

The paper in the current issue of the Bulletin by Lemouchoux and colleagues from Aberdeen provides a close-up look at service provision for eating disorders in Scotland (this issue, pp. 256-260). The Aberdeen group have previously conducted excellent epidemiological work on eating disorders in North East Scotland, establishing a sound needs-base for service planning (Reference Eagles, Johnston and HunterEagles et al, 1995). The present questionnaire-based survey identifies a bleak picture of “substantial variation and significant gaps in service provision across Scotland” with specialist expertise spread very thinly. The range of services offered is limited, with little day care or community facilities. One-third of the Scottish population has no access to NHS specialist eating disorder services and specialist in-patient provision is completely absent from the NHS in Scotland. No mention is made of any after-care provision, e.g. specialist rehabilitation hostels for people with eating disorders or provision of services for carers. I suspect the paper's silence on these topics speaks for itself.

The situation in Scotland is by no means unique. Two College reports have been conducted on service provision for eating disorders in the UK. The first of these reports was released in 1992 (Royal College of Psychiatrists, 1992) and the second, conducted in 1998 in conjunction with the Consumers' Association, is awaiting publication (Royal College of Psychiatrists, 2001). While some progress has been made since the early 1990s in terms of provision of eating disorder services nationwide, there continues to be a ‘postcode lottery’ of service provision with major under-provision or absence of services in many areas outside the South East of England.

These sobering findings appear in an even starker light when put into the context of what we know about the severity of eating disorders and their treatments. Anorexia nervosa and bulimia nervosa are chronic, often debilitating, disorders with high levels of psychological and physical comorbidity. The average duration of anorexia nervosa is 6 years. There is evidence that the course of the illness has become more severe in the past few decades (for a review see Reference Treasure, Schmidt, Thornicroft, Brewin and WingTreasure & Schmidt, 2001). Case register data from Denmark show increasing admission rates for eating disorders over the past decade (Reference Munk-Jørgensen, Møller-Madsen and NielsenMunk-Jørgensen et al, 1995), despite an overall reduction in the admissions for all other psychiatric illnesses. The mortality of anorexia nervosa is higher than that of any other functional psychiatric disorder and may be rising (Reference Møller-Madsen, Nystrup and NielsenMøller-Madsen et al, 1996). The quality of sufferers' lives is poor and the burden on their carers is as high as that in individuals with psychotic disorders (Reference Treasure, Schmidt, Murphy and MurphyTreasure et al, 2001).

Specialist out-patient psychotherapies are the treatment of choice for most cases of anorexia nervosa and bulimia and are more effective than generic out-patient support or medication. For those with severe anorexia nervosa needing admission there is evidence that specialist services are better than generic services at restoring weight and reducing mortality.

The paper by Lemouchoux and colleagues ends with an outline proposal for a national Scottish strategy for the development of eating disorder services. There is an additional challenge for service planners in areas like Scotland with geographically dispersed populations, and this concerns the provision of the infrastructure, training and support for the use of novel technologies. There is encouraging evidence that internet-based interventions (Reference Winzelberg, Eppstein and EldredgeWinzelberg et al, 2000) do have a role to play in the treatment of eating disorders and other new technologies like telemedicine may have a lot to offer too.

Why is it that some messages are slow to filter through to the wider psychiatric community and in particular those responsible for strategic planning and purchasing of services? Eating disorders are stigmatised and are still widely seen as self-inflicted conditions (Reference Gowers and ShoreGowers & Shore, 1999). Health professionals (Reference Fleming and SzmuklerFleming & Szmukler, 1992) see these patients in a similarly negative light to those who take recurrent overdoses, another group of patients whose needs are widely neglected.

Are things changing? Gradually, a political will to treat eating disorders seriously seems to be emerging. The recent British Medical Association report (2000) on eating disorders and the Summit of the Cabinet Office's Women's Unit raised many important points about prevention and service provision. The country's new mental health csar, Professor Louis Appleby, made a public commitment to improving services (Woman's Hour; Friday 24 June 2000, Radio 4). The topic of eating disorders has been put forward to be addressed by the National Institute for Clinical Excellence. Let's hope this will translate into tangible improvements at the coalface of clinical practice.

References

British Medical Association (2000) Eating Disorders, Body Image and the Media. London: British Medical Journal Publications.Google Scholar
Eagles, J. M., Johnston, M. I., Hunter, D. et al (1995) Increasing incidence of anorexia nervosa in the female population of Northeast Scotland. American Journal of Psychiatry, 152, 12661271.Google ScholarPubMed
Fleming, J. & Szmukler, G. (1992) Attitudes of medical professionals towards patients with eating disorders. Australian and New Zealand Journal of Psychiatry, 26, 436443.CrossRefGoogle ScholarPubMed
Gowers, S. G. & Shore, A. (1999) The stigma of eating disorders. International Journal of Clinical Practice, 53, 386388.CrossRefGoogle ScholarPubMed
Møller-Madsen, S., Nystrup, J. & Nielsen, S. (1996). Mortality of anorexia nervosa in Denmark 1970 – 1987. Acta Psychiatrica Scandinavica, 94, 454459.CrossRefGoogle ScholarPubMed
Munk-Jørgensen, P., Møller-Madsen, S., Nielsen, S., et al (1995) Incidence of eating disorders in psychiatric hospitals and wards in Denmark 1970–1993. Acta Psychiatrica Scandinavica, 92, 9196.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (1992) Eating Disorders. Council Report CR14. London: Royal College of Psychiatrists.Google Scholar
Royal College of Psychiatrists (2001) Eating Disorders in the UK. Policies for Service Development and Training. Council Report CR87. London: Royal College of Psychiatrists, in press.Google Scholar
Treasure, J. & Schmidt, U. (2001). Needs assessment and eating disorders. In: Measuring Mental Health Needs (eds Thornicroft, G., Brewin, C. R., & Wing, J.) (2nd edn) London: Gaskell (in press).Google Scholar
Treasure, J. & Schmidt, U., Murphy, F., Murphy, T. et al (2001) The experience of care giving for severe anorexia nervosa. Social Psychiatry and Psychiatric Epidemiology, in press.Google Scholar
Winzelberg, A. J., Eppstein, D., Eldredge, K. L., et al (2000) Effectiveness of an internet-based program for reducing risk factors for eating disorders. Journal of Consulting and Clinical Psychology, 68, 346350.CrossRefGoogle ScholarPubMed
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