The True Cost Of The NHS's Inability To Deal With Eating Disorders
The Debrief: Writing from one of London's only specialist treatment wards, Eleanor Taylor-Davis asks why mental disorders, like bulimia, which have some of the highest mortality rates, are so seriously overlooked?
It’s 6.30am and I’m pacing my room impatiently, I open my door for the tenth time that morning and poke my head into the unlit corridor, checking again if the bathroom is still occupied. It is. Frustrated, I pick up my journal and start scribbling in it aggressively.
I’ve been on the Phoenix Unit eating disorders ward for a while now and every morning is the same. It’s not my fellow patients at fault; shower time is the only privacy you’re afforded in this place (24-hour supervision gets tedious after a while) and with only two showers shared between nineteen female patients there’s an inevitable morning rush for the bathroom. That recent building works added five more rooms to an already overcrowded ward (a result of on-going sale of the hospital’s grounds) has not only worsened the fight for facilities but also added to the workload of already overburdened staff, under which conditions and standards will inevitably slip.
Sadly, I wasn’t surprised at this lack of resources when I joined this ward six weeks ago; you need only give the papers a cursory glance to be aware of the severe funding cuts the NHS has recently been subjected to. While this financial blow has affected the service as a whole, some departments have fared better than others and one of those hit hardest has been mental health.
Having been diagnosed with multiple conditions (Bi-Polar Disorder, clinical depression, anorexia and bulimia) I’ve been passed from pillar to post between boroughs and specialists as they try desperately to save money wherever they can and still provide me with treatment. Having finally – after a two year wait – been taken on by Barnet, Enfield and Harringay Mental Health Team last year, I began receiving outpatient treatment for my on-going anorexia and bulimia.
Despite the Government promising a countrywide reformation of mental healthcare system most services remain shockingly under-resourced and at risk of further funding cuts. As a long-term user of mental health services, I speak from experience about how these impact the people who need these services the most.
I’ve suffered with eating disorders, in various forms, for as long as I can remember. My first official diagnosis in 2007 was followed by a referral to the now defunct Russell Unit Eating Disorders Team in Kings Cross. Under their care I was assessed and subsequently placed on a waiting list for treatment. There I remained for two years before finally deciding to resume my degree outside of London, in an attempt to get on with my life. In doing this I cut myself off from any support proffered by my borough in London. As a new resident in a small Cornish town I was back to square one: round two of the waiting game. I had to hold tight while they worked out what to do with me.
Skip forward a few years and it’s been much the same story; assessments and waiting lists with a few brief stints of CBT in between. With all of this in mind I was sceptical when first taken under the Phoenix Unit’s wing; I’d done enough research to know that treatment-wise all the NHS offers for bulimia (my dominating disorder at the time) is CBT and I adamantly refused it; my past experience with the treatment proved ineffective and I found any advice offered superficial and inadequate for the intensity of my issues. CBT is a controversial treatment, with many people claiming it isn’t always as effective as officials might like it to be.
So, once I’d shuffled down yet another waiting list I was instead assigned a ‘specialist liaison worker’ to meet with fortnightly. Although my support worker was lovely and proved a great person to rant at for an hour I’m still unsure of what her actual role was; she helped very little in alleviating symptoms and actually my condition worsened while under her care. What I needed at a pivotal time in my illness was specifically tailored support from a trained professional, unfortunately – through no fault of her own – this nurse was not unable to provide this. Like CBT, this type of service is relatively cheap (minimal training required) and aims to superficially treat symptoms with day-to-day solutions to combat disordered behaviours. What this support worker did do was check in with me, taking note of my weight, restrictive and purgative behaviours and obsessive exercising. It was through this that the service noticed my sudden and rapid weight loss over the past 6 months that resulted in the admission which means that I’m sitting on a hospital ward writing this right now.
Why did it take so long from my first diagnosis to me finally receiving the intensive treatment I needed all those years ago? Why are mental disorders, like bulimia, with the highest mortality rates so overlooked? While mental healthcare remains hugely under-funded, eating disorders continue to be a largely ignored area with resources which can, at best, be described as inadequate.
This is particularly true when it comes to the treatment of bulimia for which CBT (alongside medication of course) is the chiefly prescribed therapy. As the UK’s go to treatment for a myriad of mental illnesses (anxiety disorder, depression, post traumatic stress disorder et al) CBT epitomizes the modus operandi of our Government’s attitude to mental health treatment today: low cost, fast turnaround and with minimal face-to-face contact – on average a total of 2 hours 15 minutes.
So although my symptoms had been both dangerous and detrimental to my health for years –the only type of therapy available to me was one now offered in computerized and telephone format. It wasn’t until my weight plummeted and my symptoms developed a more anorexic nature that my case was deemed serious enough for intensive inpatient treatment. In fact two weeks prior to my admission I was told that, at BMI 16, my weight was technically still too high to be admitted. For someone with a severe eating disorder this is a red flag to a bull and sets a new – potentially fatal – challenge. It’s a careless way to deal with someone who has a complex condition such as mine and – feeding the low self esteem that goes hand in hand with eating disorders - left me feeling like a ‘failed anorexic’ unworthy of treatment. It’s absurd when you think about it: they told me I wasn’t thin enough to qualify for NHS care. Me, someone with a compulsive psychiatric eating disorder.
I’m endlessly grateful that this service exists, if nothing else it’s provided a respite from myself; a safe space where temporarily at least I’ve been physically unable to inflict harm upon myself. And, although my looming discharge date presents a whole new set of challenges – prevention from relapse, dealing with suicidal thoughts without the safety net of 24 hour supervision to name but a few – I have to remember that with only 34 beds allocated for eating disorder patients in the whole of Greater London I was extremely lucky to get one in the first place. I can't overlook how long I had to wait to be seen here, I had literally waited for years. And, although that’s not enough, with continuing cuts to the NHS and it’s gradual privatisation it’s the best I can expect.
That said, as much as I remain grateful for my time and treatment here, I can’t escape the feeling that this ward serves as a cattle farm of sorts; pumping patients full of protein and pills then releasing them to free up beds for the next caseload... Since being here I have received the bare minimum of therapy and, from speaking to the other young women on the ward, Ive learned that multiple admissions are the norm for the vast majority of patients here.
The fundamental flaw here is clear, the current system is a total false economy; by doing a quick turnaround with patients the NHS saves money in the short term, but if enough time, money and thought was put into the really treating the disorder on the first admission the chances of readmission would be greatly reduced. Not only would this result in financial savings for the NHS, so too would it save millions of people more suffering and the detrimental effects of recurrent relapses of what can be life-threatening eating disorders.
It’s not just eating disorders that the NHS seems ill-equipped to deal with, FOIs submitted earlier this year revealed that women’s health needs are not being ‘considered adequately’ across the board.’
I’m trying to stay optimistic, but having received just ten weeks of treatment for a deeply embedded illness spanning over ten years of my life, I don’t hold much hope for my chances of sobriety once discharged, so called community support’ (an initiative introduced in the late 90s aimed at deinstitutionalising mental health treatment) has provided nothing of the sort for me over the last decade and knowing I’ll be back under its ‘care’ in a few short weeks terrifies me. As it stands no Care Plan Approach (an official term for post discharge support) has been put in place for my release and as the date looms closer my anxiety grows. What was supposed to be a sanctuary, a safe space to save me from myself has in fact been quite the opposite, and as I prepare to leave I find myself with the same – if not more – anxieties than I carried with me to the ward.
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