Rising demand overwhelms NHS eating disorder services
GPs say only children and young people dangerously ill are able to access treatment
stem4’s Worth Warrior app, a new free, safe, evidence-based app to help with
body image and early eating difficulties has been used by 2,000 young people since January 2023
Most GPs believe eating disorder services for children and young people are failing: over half (60%) of them say it is now very difficult for even dangerously ill young patients to access the specialist treatment and care they need to get well, according to a new survey conducted by youth mental health charity stem41.
While NHS child and adolescent eating disorder services are generally rated as easier of access than other mental health services, demand for treatment is now so great that services are seen to be “in crisis”, or as one GP said, “We are fighting a losing battle.”
The new survey of more than 1000 GPs by youth mental health charity stem4, which has been tracking GPs’ views of NHS mental health services for the past six years, finds that six in ten (60%) GPs now fear that their young patients will come to harm through lack of access to the treatment from NHS child and adolescent eating disorder services (whether inpatient services or community eating disorder teams).
A GP in the Southwest of England said:
“The last patient I referred with moderate eating disorder and severe body dysmorphia was not seen for months. He was then seen briefly after an overdose, and then waited a further 4 months for input from CAMHS. I saw this child every week, then fortnightly for over a year for 20 minutes minimum and calls to support the mother every few weeks because no services were available for him for so long.”
Rising demand
From 2015/16 to 2020/21, documented eating disorders among young people rose by 90%, with an 84% rise in hospital admissions for eating disorders in just five years, according to the Royal College of Psychiatrists2.
Eating disorders carry one of the highest levels of mortality among mental health disorders. Peak onset coincides with adolescence and early adulthood, a sensitive time when the brain is still developing. In the nationwide survey of 1,004 GPs conducted by MedeConnect Healthcare Insight on behalf of stem4, a third (34%) of GPs say they are seeing more young patients presenting with eating disorders and body image difficulties A third of GPs say they are now seeing at least 20% more young patients aged from 5 to 18 each month than they did a year ago.
In 2022 stem4 warned that urgent action was needed in the form of more effective evidence-based early mental health interventions to deal with the rising number of young people with eating problems and body image difficulties. Then, in January 2023, following a survey of 1,024 12-21 year-olds, stem4 reported that 17% of these young people are experiencing body image issues (21% of females 13% of males), and 14% are experiencing eating difficulties, such as restrictive eating, binge eating, and purging/vomiting (16% of females 10% of males). Of those in need of care, just one in ten were receiving treatment.3
A GP in Scotland commented:
“Disaster, underfunded, staff leaving, teams stressed and miserable because they can’t see these young people, it’s horrible. The NHS is collapsing in front of our eyes. Eating disorders has increased exponentially with Covid. Very few GPs even know how to identify an eating disorder or what to ask/look for, ditto some of the pediatrics in local hospitals, we only have endless locums anyway.”
Long waits for treatment
According to current NHS guidelines for inpatient and eating disorder day services, 95 per cent of children and young people in need begin treatment within one week for urgent cases, and within four weeks for non-urgent cases. Despite these targets, GP’s say only 6% of their urgent referrals now start treatment within one week. This rises to 17% within 1-4 weeks and 12% within 4-12 weeks, while 24% are waiting 12 weeks or more. Meanwhile, 3% of GPs say that in-need and dangerously ill young patients have been refused access to specialist treatment and care over the past 12 months.
A GP in the South East, said:
“CAMHS is woefully under-resourced to manage eating disorders and cannot cope with the workload. As a result, many children with significant issues are ‘signposted’ elsewhere, i.e. they are not given the help they need and deserve. This leads to higher illness severity, lack of early preventative treatment, and is letting thousands of teenagers down. CAMHS also underinvests in the numbers of medical and support staff needed for physical monitoring of eating disorder patients due to lack of funding. They need more doctors, more funding, more eating disorder specific units, and more therapist access.”
Another added: “Recently a patient has been seen 5 months after referral, their BMI had dropped from 16 to 14.5.”
A GP in the West Midlands, said:
“Usually young people present near death and require an ambulance, and my heart sinks.”
Another added: “It takes two months plus before referrals are even triaged, then a questionnaire goes to family. Another two months before they hear anything, and are often rejected at this point, or discharged. It’s shockingly bad.”
Not sick enough to warrant treatment
While research studies show that recovery is possible if an eating disorder condition is identified and treated at the earliest opportunity, two-thirds of GPs say that access to treatment has become impossible (23%) or difficult (53%) for their under-19s with early, less severe symptoms. GPs believe that 28% of referrals for mild eating disorders are rejected by overwhelmed NHS child and adolescent eating disorder services. When it comes to referrals for body image difficulties, 20% are rejected with the assertion that these patients are not sick enough to warrant treatment.
Meanwhile, GPs say just 23% of young patients with moderate eating disorder difficulties, and 10% with milder symptoms start treatment in under 12 weeks. Only 8% of young patients with body image difficulties start treatment in under 12 weeks.
A GP in the North West, said:
“Referrals are rejected until such a point that active harm is occurring, and then GPs are expected to conduct almost all of the physical and mental health care support. Patients actively losing weight are discharged from anorexia services with passive aggressive letter to GPs. Paediatrics are fed up having children dumped into their care with severe biochemical change. I am fed up having to watch children deteriorate before specialist help is accessible.”
stem4’s Worth Warrior a free, safe, evidence-based app to help young people with body image and early eating difficulties
To help young people struggling to access treatment, youth mental health charity stem4, with a grant from the NIHR, has created the Worth Warrior app. It is a free, evidence-based, mobile phone app to help young people overcome issues of negative body image, low self-worth, and related early-stage eating difficulties or eating disorders. The Worth Warrior app, recommended for ages 12 and above, has been developed by Consultant Clinical Psychologist Dr. Nihara Krause, CEO and founder of youth mental health charity stem4, in collaboration with young people and clinician feedback. Using principles of Cognitive Behaviour Therapy for Eating Disorders (CBT-E), Worth Warrior provides a range of helpful activities and information, based on the notion that eating and body-related issues can be helped through learning to challenge and change negative thoughts, emotions, and behaviours towards body image, and improve underlying low self-worth.
Over 3 million young people have made use of stem4’s NHS-approved range of evidence-based apps, starting with Calm Harm for young people who self-harm, first launched in 2014 followed by 4 further apps.
Dr Nihara Krause, Consultant Clinical Psychologist, and CEO and founder of stem4, says:
“It is truly shocking to learn from this survey of GPs’ their experiences of dealing with young patients with eating disorder and body image difficulties. It is equally disturbing that so many vulnerable young people in desperate need of urgent help are being forced to wait for so long, or are refused unable to access suitable care.
“We know that young people with complex mental illness such as eating disorders will experience deterioration as they wait longer for treatment. With young people there is often a critical window for treatment. Delay in treatment increases risk, and you can expect problems in application to study or work, relationship issues, and other emerging co-morbid mental health issues.
“Back in 2016, well before the pandemic, most (87%) GPs told stem4 they expected pressure on services to increase due to a steady rise in the numbers of young patients experiencing mental health difficulties, combined with years of underfunding. Yet despite £1.4 billion of extra investment made in children and young people’s mental health service between 2015 and 2021, very few of the GPs surveyed say they have seen an increase in capacity to meet their reported demand.”
GPs say lack of access to treatment has consequences
As a consequence of rising demand for treatment, combined with long-term underinvestment in eating disorder services, GP’s say lack of access to NHS child and adolescent eating disorder services (both inpatient services and community eating disorder teams) has led to:
- Repeat attendance appointments at the practice (44%);
- Patients’ symptoms worsening to the extent that the young person has presented at hospital Accident and Emergency (32%);
- Referral of the young person to a local charity for care in the community, group support and parent support (26%);
- A private referral to an eating disorder service if the family can afford to pay (25%);
- No further presentation of the young patient, or not until they are very physically unwell and need urgent referral (17%);
- Regular monitoring of patients in the surgery, such as blood tests, weight and measurements, ECGs, and blood pressure to ensure the patient physical health is not deteriorating (16%);
- Treatment of the GP’s patient in a general inpatient paediatric ward (14%);
- Referral of the young person back to their school (12%);
- Referral of the young patient to an NHS inpatient unit outside the local area, sometimes hundreds of miles away (7%);
- Treatment of the young patient in an adult psychiatric inpatient ward, or general adult ward (3%).
– Ends –
Notes to editors
Contact
For queries or interview / case study requests/regional breakdown across the UK, contact:
Senso Communications
Penny Lukats – 07775 992350 penny@sensocommunications.com
About the surveys
References
- Survey of 1,004 regionally representative GPs across the UK, carried out by MedeConnect Healthcare Insight between 14 & 24 December 2022. GP respondents didn’t know about the subject matter in advance, and the questions were included in MedeConnect Healthcare Insight’s monthly omnibus GP survey.
- BMJ, https://www.bmj.com/content/377/bmj.o1256.full, last accessed 21 03 23
- Survey of 1,032 regionally representative young people in the UK, aged from 12 to 21 carried out by Survey Goo between 21 & 27 November 2022
For interviews and regional breakdown of survey results across the UK, please contact:
SENSO Communications
Penny Lukats, 07775 992350, penny@sensocommunications.com
About stem4
stem4 is an award-winning charity that supports teenagers with their mental health. It provides evidence-based education, builds resilience, enhances motivation to change, and provides signposts to ensure early intervention and action. stem4 focuses on commonly occurring mental health issues in teenagers including eating disorders, anxiety, depression, self-harm and addiction.
The charity works with students, parents and teachers in secondary schools and colleges, and with health professionals such as GPs and school nurses through its conference programme and through its digitally delivered workshops suitable for PHSE in schools. stem4 is also included in the Royal College of GP toolkit.
■ stem4’s free, evidence-based, smartphone apps
With children and young people experiencing difficulty and long waiting times in accessing effective treatments, stem4 has developed four NHS-approved smartphone apps, all based on evidence-based strategies, to help young people in the treatment of and recovery from their mental health difficulties. These apps have been downloaded and used over 2 million times. These apps include:
- Clear Fear, which uses the evidence-based treatment Cognitive Behaviour Therapy (CBT) to help manage the symptoms of anxiety;
- Calm Harm, which uses the basic principles of an evidence-based therapy, Dialectic Behaviour Therapy (DBT) to help manage the urge to self-harm;
- Move Mood, which uses Behavioural Activation Therapy to help improve low mood and manage the symptoms of depression;
- Combined Minds, which uses a Strengths-Based approach that has been shown to be effective in recovery, providing practical strategies for families and friends to support teenage mental ill health, including eating disorders
- Worth Warrior, which uses the principles of Cognitive Behaviour Therapy for Eating Disorders (CBT-E) to overcome issues of negative body image, low self-worth, and related early-stage eating difficulties or disorders.