Endless NHS waiting times are behind a surge in hospital admissions for eating disorders – not social media or fad diets, says former sufferer EVE SIMMONS

Eve Simmons, above, says the truth behind a surge in hospital admissions for eating disorders lie in endless NHS waiting times

About a month ago, I was startled by an ominous voicemail message. ‘I’m calling you from Chelsea and Westminster Hospital. Your GP has informed us you are in need of treatment,’ the voice said.

I was utterly perplexed. Not to mention alarmed. Treatment for what? Had my GP found something sinister in my latest blood sample and forgotten to tell me?

‘Please call the eating-disorder service as soon as possible to book your appointment,’ she continued.

Then it suddenly all made sense. The woman was calling in relation to an appointment I’d had with my GP almost TWO YEARS before, in which I’d asked to be referred for a type of psychotherapy specific for people who have suffered eating disorders.

In my early 20s, I was diagnosed with and received treatment for anorexia – the deadliest of all mental illnesses. Since finishing treatment in 2016, I’ve had a successful recovery. But at the end of 2018, due to a culmination of stressful events, I became unusually anxious about my body again. My paranoia kicked in – what if the illness returned? I decided to seek out a therapist, just in case.

Thankfully, it didn’t return and the anxiety dissipated within a few weeks. But what if it hadn’t? I would have faced almost two years of battling the vicious illness that almost killed me, without any medical intervention.

I’d have got sicker, weaker and more entrenched in my disordered thoughts.

The inevitable result – which I faced five years before – is ending up so sick I would be admitted to hospital. So, I was hardly surprised when I read Friday’s headlines, about a shocking rise in the number of eating-disorder patients being admitted to hospitals.

According to the latest figures from NHS Digital, inpatient admissions for eating disorders – mostly anorexia – rose by almost 40 per cent in just two years.

Almost a quarter of these cases were children, which are classed as all those under 19 years old. The initial verdict, on Twitter and in various newspaper reports, seemed to be that the rise was down to social media exposing youngsters to faddy diets and skinny celebrities every waking minute. 

Now, I’m usually the first to call out showbiz types accountable for promoting nonsense juice diets to their vulnerable audiences. But on this occasion, I don’t think they’re to blame. Firstly, three-quarters of eating-disorder patients in hospital are adults – my age, and older. In fact, data seen by The Mail on Sunday shows that one in five are aged 40 or over. And numbers of older adults being hospitalised have risen at a faster rate than children.

It’s highly unlikely their illness was ‘triggered’ by something they saw on Instagram. The problem, I think, lies instead with the endless waiting lists and shoddy outpatient treatment, which prevents early and effective intervention.

The statistics prove my point.

One in five adults are waiting at least four months for an initial assessment, with some waiting more than a year, according to a recent report by Beat, the UK’s leading eating disorder charity. Despite the Government’s efforts to restrict children’s waiting times to four weeks in some areas of the UK, a third of cases don’t meet the target. And that’s if GPs even spot there is a problem. According to a 2017 report, almost a third of them miss the tell-tale signs. I am afraid to say this is a problem that goes far beyond show-off social media celebrity culture.

My first encounter with a lengthy NHS waiting list was five years ago, when, aged 22, I was first diagnosed with anorexia by my GP. It took four months before I saw an eating-disorder specialist.

By the time my clueless GP had fumbled around for a local service, and the psychiatrist could fit me in, my condition had spiralled further.

After an initial assessment with a mental-health worker, I waited a further three weeks for my next appointment. I was promised the gold-standard treatment: therapy, psychiatric monitoring and a meal plan, constructed by an expert dietician. It would be a further three months before I saw a psychologist. This despite the fact that, when treating severe eating disorders, speed is crucial.

Averil Hart, 19, as a healthy teenager. She died in 2012 from anorexia following critical gaps in support by outpatient care teams

‘If we intervene early, there’s more chance a hospital admission will be avoided,’ says Professor Janet Treasure, psychiatrist and head of eating-disorders research at King’s College London.

‘Often we can prevent the thoughts and behaviours from becoming more entrenched, and stop people losing even more weight. If you’re underweight for a long time, there’s changes in the brain that make treatment far more difficult. We know that early intervention cuts time spent in hospital and increases the chances of long-term recovery.’ During my four-month delay, I lost half a stone more and became increasingly anxious about every morsel that passed my lips.

By the time I reached my second appointment, it was too late.

You see, once your body reaches a certain weight, kidney and liver function is compromised, and there’s a significant risk of sudden heart attack.

The brain goes into ‘starvation mode’, making you even more consumed with relentless thoughts about food and body weight.

So a few weeks later, I was admitted to hospital for constant medical monitoring. I endured six weeks of being confined to a hospital ward, with every meal and toilet trip supervised, and I was forbidden from venturing outdoors. Visits from loved-ones were limited to twice weekly, for a couple of hours. In the end, it saved my life. But it needn’t have been necessary.

OF the 1.2 million Britons affected by eating disorders, roughly 200,000 will end up in hospital. But evidence shows that if help is offered immediately, admissions can be avoided.

In one 2011 study, adults with eating disorders who engaged in psychological therapy within three months of diagnosis recovered quicker than those who waited longer. About 60 per cent of sufferers who wait for treatment will need continued, intensive care, compared to just 30 per cent of those referred within a month or two. Community intervention studies have shown that when outpatient care is fast – and effective – hospital admissions drop significantly.

NHS chiefs have taken note of these studies – but only with regards to children and teenagers.

In 2014, young people’s eating-disorder services received £150 million of extra funding, intended to improve outpatient treatment.

Two years later, the Government introduced waiting-time targets for children and young people – all under-18s must now see a mental- health specialist within a month of a GP referral. In urgent cases, this is reduced to a week. But adults received no such assurance.

So perhaps it’s no surprise that adults make up three-quarters of the eating-disorder inpatient population. In 2018, one in five eating disorder inpatients were aged over 40. Since 2012, the number of adults receiving hospital treatment for an eating disorder has climbed at a faster rate than that of children.

The number of inpatients over the age of 40 alone have doubled in just eight years – from roughly 2,000 to more than 4,000.

‘We’re starting to see the benefits of the investment in children’s services, with reduced waiting times in some areas,’ says Tom Quinn from Beat, Britain’s eating disorder charity. ‘But adult treatment is in a significantly worse state. Delays of up to a year or two are ludicrous. An awful lot of people end up in hospital because their illness is not treated effectively enough in the community.’

Renee McGregor, an independent eating-disorder dietician, often ‘plugs the gap’ in between NHS appointments. ‘I have people waiting about a year for an initial appointment, so they come to see me,’ she says.

‘They wait months for an initial assessment, and then they have to wait another month or so for a second session. There’s a risk they get more obsessive, or become even more underweight because there’s no one supporting them to challenge the behaviours.’

Quinn agrees: ‘There isn’t enough community care around the country. And even if people do get into treatment, it’s often just one appointment for an hour every week, which isn’t enough for some severe cases.

‘They can continue to get worse even if they are in treatment.’

Prof Treasure, who works in a specialist eating-disorder unit at the Maudsley Hospital in South London, says there’s currently a long waiting list to access their outpatient service.

‘We have limited resources and staffing can be problematic,’ she says. ‘People go off on maternity leave or move on and then it takes time to recruit and train replacement staff.’

For some patients, the lack of provision can add years to their recovery. But for others, the consequences are fatal.

Take 19-year-old Averil Hart, who died in 2012 from anorexia following delays and critical gaps in support by outpatient care teams.

A review into her death by the Parliamentary and Health Service Ombudsman said she was failed by ‘every NHS organisation that should have cared for her’ – including the Norwich Clinical Commissioning Group, which runs the Norfolk Community Eating Disorder service and was entrusted with her care.

Recent reports show there are still lengthy delays to access the Norfolk service – patients can get in only once another is discharged.

Averil is one of five anorexia patients to have died who were at some stage under the care of NHS eating-disorder units within the Cambridge and Peterborough Foundation Trust, the other four of them died between 2017 and 2018. Systemic failures in the NHS system of care were noted as contributory factors by coroners.

‘People are dying unnecessarily from eating disorders,’ says Dr Agnes Ayton, chairman of the faculty of eating disorders psychiatry at the Royal College of Psychiatrists. ‘We have some people with a body mass index of 12 stuck on a waiting list. Now we are calling for adults to be a priority.’

CLEARLY there’s a funding issue.

Ms Hart while seriously ill in hospital, with her father Nic Hart. A review into her death by the Parliamentary and Health Service Ombudsman said she was failed by ‘every NHS organisation that should have cared for her’

‘With children’s services, it’s just taking a while to see the results of the increased funding to community teams,’ says Quinn, who is hopeful hospital admissions of children will reduce in the coming years. But for adults, ‘we’re asking for more funding, and faster’, he says. ‘There hasn’t been enough research into how much money is needed.’

Prof Treasure says the process by which each local adult NHS mental-health team receives funding is problematic, too. ‘Adult inpatients are funded directly from NHS England, whereas outpatient services receive their money from individual, local authorities or trusts,’ she says. ‘There are essentially two different pots.’

Some argue this leads to a lack of motivation to keep people out of hospital among local adult mental- health teams.

‘The separate funding avenues mean there’s no financial incentive to save money from hospital admissions, and reinvest it in community care,’ explains Quinn. ‘It would be easier for them to plug more money into community teams if they knew they were making savings by reducing hospital admissions.’

The Government has pledged to change this funding system by April this year, as part of the NHS long-term plan.

Local authorities will divvy up the cash between inpatient and outpatient services themselves.

‘The hope is there will be more parity between investment in the two teams and an increased focus on strengthening community teams,’ says Prof Treasure.

NHS England is currently piloting increased investment for adult outpatient services across the country, to test how much extra funding is needed.

DOES this mean that social media is innocent? Not entirely, say the experts. ‘Some would say that images and messages seen on social media contributed to their eating disorder,’ says Quinn. ‘But putting this stark rise in hospital admissions down to social media would be dismissive and unhelpful. These illnesses are complicated.’

Indeed, images of celebrities’ rock-hard abs didn’t cause my eating disorder – but they certainly didn’t help. ‘There’s no doubt that aspects of social media can help to maintain the illness,’ says Prof Treasure. ‘Being very thin or eating a faddy diet is normalised on platforms such as Instagram – this keeps people stuck in their behaviours, or disguises them as normal.’

But as for a new ‘epidemic’ of severe eating disorders – as suggested in various headlines – Prof Treasure, who has worked with eating-disorder patients for more than 30 years, is less convinced.

‘The number of new cases of anorexia hasn’t changed dramatically,’ she says. ‘We have seen an increase in people seeking treatment for bulimia and binge-eating disorder, but these patients aren’t usually admitted to hospital.

‘The figures may be showing people who’ve been admitted to hospital for the second or third time.

‘Many eating-disorder patients would have previously been in adult general psychiatric wards, so wouldn’t be included in any data collection for eating disorders. But now they’re in new, specialist eating disorder wards so they get picked up.’

Prof Treasure and Quinn think increased awareness about mental illness over the past decade may have contributed to rising numbers too. ‘More people are talking about it, so perhaps are more likely to seek treatment,’ says Prof Treasure. ‘The sad truth is that there still isn’t enough research into what exactly causes this very serious condition.’

Prof Treasure is now running a study called Triangle to see if intensive outpatient treatment, given soon after diagnosis, can reduce hospital admissions. She is already seeing promising results. ‘We do know that intervening early will give patients the best possible chances of making a full, long-lasting recovery, as quickly as possible.’

While I’d never say I am ‘fully recovered’ (I believe it’s setting myself up to fail), I’m certainly at my healthiest – body and mind.

I’d be lying if I said restrictive or self-punishing thoughts never crop up. But these days, I rarely act on them. Would they be there had I not missed those crucial four months of treatment? Perhaps not. But at least I can say I got out alive – too many aren’t as lucky.

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