It may be depressing, it may be shocking but, to be honest, it came as no surprise to me: inpatient hospital admissions in England for eating disorders have increased by 84% in the last five years, according to the Royal College of Psychiatrists. Children and young people are the worst affected, with a 90% jump, but adults have also seen a 79% increase in admissions over the same time. These are figures that should shame us – and spur action.
An inpatient admission should be an absolute last resort. It involves 24/7 monitoring and weighing, being observed eating timed meals and snacks. Some patients will arrive voluntarily, others will be there because they have been sectioned. It should be the end of the line treatment when a patient’s life is seriously at risk. The huge rise in admissions means that people are suffering alone without support for such a long time that their lives are at risk before anyone intervenes. That cannot be right.
I was terrified when I was admitted into hospital with an eating disorder. It did the job of saving my life but I became very institutionalised while I was in there – my life was completely on hold.
Eating disorders are one of the deadliest mental illnesses but the funding and support they receive has never met the demand. The government seems intent on blaming the pandemic for the recent rise in people of all ages receiving treatment, which ignores that we are where we are due to a lifetime of underfunding of services and research and years of dangerous health initiatives such as calorie counting on menus that have normalised disordered eating.
Eating disorders are also a hugely stigmatised illness. They are often seen as a lifestyle choice, a phase, or something that a person will grow out of, rather than an insidious and dangerous mental illness that has complex roots and manifestations. There is still an assumption that they only affect white teenage emaciated girls – just look at hospital admissions for black, Asian and minority ethnic people, which are increasing more rapidly than those of white ethnicities, to see how invisible eating disorders are in these communities until they becomes life-threatening. Stigma increases the shame that many people feel, but also stops many from reaching out for support – which is a massively difficult thing to do when your mental illness is telling you not to – which of course then contributes to high mortality rates.
So many people go to their GP or end up in hospital A&E departments only to be told, “You aren’t thin enough to have an eating disorder” or, “You don’t look like you have an eating disorder.” That is why I have spent years on a campaign called #DumpTheScales to ban minimum BMI limits for treatment, which many NHS trusts have in place, which only encourage people with restrictive eating disorders to lose even more weight to be deemed worthy of treatment. I hear all the time from people who have been told by their GPs that they can’t have an eating disorder because of their weight, age, ethnicity or gender.
The Royal College of Psychiatrists is today launching new guidelines to help healthcare workers identify eating disorders – which range from anorexia and bulimia to binge eating disorder and eating disorders not otherwise specified – in good time to mitigate the worst effects such as heart failure, osteoporosis and infertility to name just a few.
While I applaud these guidelines, the only way things will really change is with proper funding for early intervention programmes, treatment and research. Between 2009 and 2019, total UK funding for eating disorder research was just £1.13 per person affected per year, according to the charity Beat. And despite inpatient admissions spiralling, the number of beds in NHS mental health hospitals has fallen by 25% since 2010. This is a crisis and we need to prevent lives being lost as a matter of urgency. Nobody should be dying of an eating disorder in 2022. With proper support and long-term treatment, recovery is possible. But it is a long road, which requires long-term support and community-based treatment. Inpatient care is expensive, it is necessary at times, but only when all other options have been exhausted. We know that early intervention saves lives and money so why are we still intent on waiting for people to hit crisis point before helping them?
However, what these statistics fail to show us is the number of people who are struggling without a diagnosis. Those living with eating disorders, in some situations perhaps functioning at a high level, hidden in plain sight, their lives utter misery. Remember as you scroll through the news today, taking in these headlines, that behind every one of these statistics is a face, a person, a name, with a network of family, friends, loved ones who are all devastated by eating disorders.
Hope Virgo is an author and the founder of the campaign Dump the Scales
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