More and more people are being hospitalised for eating disorders – a sign that thousands are reaching crisis point – and almost a quarter of them are children and young people.
Figures released by NHS Digital at the start of January showed hospital admissions for eating disorders rose across all age groups from nearly 14,000 in 2016-17 to 19,000 in 2018-19. In 2019, there were 4,471 hospital admissions for children with eating disorders, up 8% on the year before. This included 16 children aged nine and under who were hospitalised for anorexia.
What’s behind the rise in admissions?
One factor could be greater awareness, says Tom Quinn, director of external affairs for the eating disorder charity Beat. For example, improved ability among healthcare professionals to identify eating disorders or even a result of the general public being more educated on the symptoms.
But the surge in admissions could also highlight a more worrying trend – that the number of young people with eating disorders is increasing and they’re not getting the help they need early on.
In 2019, 2,403 children under 18 years old were hospitalised for anorexia. It’s the mental illness with the highest fatality rate due to medical complications associated with weight loss, as well as the risk of suicide. A 2016 study found that in a sample of 47 girls admitted to hospital for anorexia nervosa, suicidal behaviour was present in 60% of patients and self-harm in 49%.
Emily David works on the frontline for Hampshire CAMHS (child and adolescent mental health service) and says a lot of young people are referred late into services, “so are already very unwell and require admission as part of their recovery journey”.
David, who is a lead clinical psychologist for Hampshire’s Specialist Eating Disorder Team, points out that while there are national access and waiting time standards for young people, many specialist eating disorder service are “embryonic or developing” and not fully resourced to meet demand.
“It means that young people may not be accessing specialist help as quickly as they might need,” she says. Eating disorder services are not crisis services so aren’t always able to “provide the intensity or frequency of input” that someone might need.
The 2019 NHS Long Term Plan promised to boost investment in children and young people’s eating disorder services. But it’s a slow process. Dr Agnes Ayton, chairwoman of the faculty of eating disorders psychiatry at the Royal College of Psychiatrists, wants the government to ensure eating disorder services are properly staffed.
A workforce census by the college found one in six eating disorder psychiatrist posts are unfilled. Improving staffing could help bring down waiting times and reduce the need for hospitalisation, Dr Ayton told the Independent.
Meanwhile, a recent Guardian investigation revealed at least 12 highly vulnerable people with eating disorders died over the past seven years after failings in care that led coroners in England and Wales to send official warnings to 11 hospital trusts.
Early intervention saves lives
Experts agree that early intervention is key in the successful treatment of eating disorders, as faster diagnosis and treatment usually correlates with improved outcomes in patients. “Full recovery from an eating disorder is possible and the sooner someone gets the treatment they need, the more likely they are to make a full and sustained recovery,” says Tom Quinn from Beat.
But what does early intervention actually involve? “A lot of it is around providing information and advice to adult caregivers such as GPs, education staff, parents/carers about the signs and symptoms of eating disorders as well as letting people know where and how to access help and support,” says David.
Getting to the point of accessing support can be easier said than done. Eating disorders are often shrouded in secrecy and sometimes people in the grips of a disorder – whether that’s anorexia, bulimia, binge-eating or another form of disordered eating – do not recognise that anything is wrong. This can make it hard for them to seek help on their own terms, and might make it difficult for those who want to help but do not know what to say.
Other barriers for young people when it comes to seeking help, says David, include worrying about the reactions of others, about letting people down, or that people will think they’re attention-seeking or won’t take them seriously. Some young people are confused or uncertain about what is going on, she adds, and therefore aren’t sure about who or where to go for support.
Suffering in silence
Hope Virgo, a mental health campaigner with personal experience of anorexia, believes removing the secrecy element is key to reducing hospital admissions. “I think that people are too afraid to talk about it because we are scared of triggering, saying the wrong thing or causing someone to shut down,” she says.
“Eating disorders are secondary symptoms and an unhealthy coping mechanism, but still we need to tackle both the food and the root issue. By not saying anything it means that that individual could think no one has noticed it, or that they don’t look sick, or that no one cares.
Virgo says she was about 12 when she first developed anorexia. She says the first indicator that something wasn’t right was an obsession with talking about food, dieting and exercise. At 13, she stopped eating meat, which made it harder for her mum to prepare evening meals
“I spent most evening meals out and about, talked a lot about the little food I was having and, at mealtimes, would cover my plate in salad or vegetables,” she recalls. “I became withdrawn, spending more and more time upstairs in my room, away from everything that was going on.”
As her illness worsened, there were times where someone could have said something, Virgo says – but nobody knew how to broach it. “My parents would hear me being sick and watch me not eat, but felt unable to start that conversation – it’s not their fault at all, but another reason why we need to have these chats straight away because if we don’t, behaviours get so engrained.”
Conversations may feel futile or easily shut down, but persevere, says Virgo. “The fact is if we don’t have these conversations people suffer in silence. We need to be picking them up as soon as things change. You may think your child is just on a diet, but it could also be something else.”
How to start the conversation
Virgo says she would have liked someone to have said to her: “I know you aren’t eating. What’s going on? How are you feeling?” It’s important to do this in a safe space though, she notes, away from meal times – and to follow up later.
If you are worried about your child, David notes that some eating disorder services are self-referral, so parents can phone the service directly to speak to a professional. If that’s not an option, she advises seeing your GP and pushing for a referral to your local eating disorder service; speaking to your child’s school and sharing your concerns, and talking to your child about general worries they may have or changes you have noticed. It’s important to reassure them that you want to try to understand and help – and that you will work together.
“Often young people have all sorts of catastrophic beliefs about what might happen,” says David, “so it’s about including them in decision-making as much as possible, being open and honest, transparent and trying your best to stay calm, open and responsive. Trust your gut instinct, if something doesn’t feel right and your young person is denying any problem, try to see your GP or get professional advice as soon as possible.”
Useful websites and helplines: