The importance of early intervention in Eating Disorders
The latest figures for the 12 months to October 2013 have indicated that there were 2,560 admissions for eating disorders, an 8% increase from the previous year*. Over half of these admissions are for young people aged 10 to 19, with a rise of around 15% in this age group. 15 remains the peak age for admission, with 245 admissions in this age group. Of all admissions, over three quarters are for anorexia nervosa. Interestingly, overall the percentage of admissions for males remains the same as last year at 1 in 9, although for 13 year olds, the ratio of boys to girls is much higher at 1 in 4.
It is difficult to know whether these figures indicate an increase in the incidence of eating disorders per se or whether they reflect advancements in the understanding and identification of physical risks in severely ill patients. I have seen the widespread use of tools such as the Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) and Junior MARSIPAN help to improve the physical monitoring of patients across inpatient and outpatient settings, and raise awareness among professionals of when patients need to be referred to hospital.
There has been a lot of media coverage recently concerning the shortage of adult mental health beds and in my own field of adolescent mental health, there is a similar crisis. Young people with severe eating disorders are having to be managed for weeks on paediatric wards while they wait for appropriate specialist placements; this wait for specialist treatment may be one of the reasons why our service at Priory Hospital Altrincham is seeing an increase in the severity of referred cases, with up to 70% identified as requiring nasogastric feeding by referrers.
Once a place is identified, the shortage of beds has meant that many young people have ended up in units hundreds of miles away from their families and friends, a very difficult situation for them, especially when they are so frightened and vulnerable. Parents have to endure long hours of travelling each week to visit their child and when their child is ready for home leave, they are asked to provide full support and supervision for all their child’s nutritional intake, while juggling the care of other children and jobs. I am full of admiration for them.
The eating disorder charity, BEAT, reminds us that those requiring hospital admission are just the tip of the iceberg and resources are needed to improve the provision of earlier and more effective early intervention services. In young people, the most effective interventions are family based and young people have the best outcome if these are provided within three years of the onset of treatment. At Priory Hospital Altrincham, we have developed an intensive intervention service which works closely with parents and runs three evenings a week and on Saturdays. It has had considerable success in avoiding admission for severely ill patients and has recently expanded in an effort to keep up with the demand. Our specialist nurses also run popular information sessions in schools as early symptoms are quite frequently noticed first by peers or school professionals, and many schools are keen to ensure that they know how best to respond.
* Health and Social Care Information Centre for England