Anita’s daughter Lucy started showing the signs of Anorexia Nervosa at 16. She sought help from her GP but there was no specialist treatment option available, only cognitive behavioural therapy (CBT), and Lucy wasn’t deemed “thin enough” for hospitalization. For men and women to receive a quick referral they may need to meet strict criteria: anyone over 17 may need a BMI of less than 14 kg/m2, for instance.
Lucy’s story is not unusual. The latest Royal College of Psychiatrists review of eating disorders care identifies a dangerous and deadly gap between hospitalisation and outpatient treatment. The review calls for more innovative services, such as Orri, that reduce fragmentation in the eating disorders treatment landscape. Currently, care is concentrated in inpatient facilities such as hospitals. This creates silos of expertise that only few people—usually the most severe cases—can access.
We at Orri believe that hospitalisation should be reserved for life-saving interventions such as weight stabilisation, and that daycare is otherwise the best option for long term recovery. Patients in the UK stay in hospital for 18 weeks on average. More often than not, this length of stay is unnecessary and at least some of it could be substituted with daycare.
Why? “There is no evidence that prolonging admission beyond life-saving stages gives any advantage over outpatient care,” Orri’s Director of Research, Dr Paul Robinson, says. A study conducted recently in Germany showed that, whether patients with eating disorders were hospitalised or discharged after initial stabilisation, the outcomes were the same. This adds to mounting anecdotal evidence in favour of daycare facilities such as Orri.
“There is no argument for keeping people in, for providing people with hotel services when they could be coming in every day,” says Dr Robinson, who developed part of the national guidelines for treating chronically ill patients and has authored a number of books on the subject.
Despite this, the number of people being diagnosed and entering inpatient treatment for eating disorders in England alone has risen by 7% year on year since 2009, according to BEAT, the eating disorders charity. And patients are being hospitalised for longer, potentially draining already scarce money that could be put to far better use elsewhere or for those at higher risk but don’t fit the strict BMI criteria for admission.
Aside from the financial argument for non-institutionalised care, Robinson cautions that prolonged hospitalisation is often bad for the patient too. “For most cases it’s better for them to be at home with the families, flatmates, in contact with their social network and yet having treatment at the same time. It’s the healthier option,” he says.
It is also easier to get someone to persuade someone to enroll in daycare than it is to admit them to hospital, meaning treatment is likely to start sooner—a key factor in their recovery.
NICE guidelines state that, wherever possible, patients should be treated in the community rather than as inpatients. Yet there isn’t enough daycare in the UK and people aren’t accessing it when they should do.
As Susan Ringwood writes in BEAT’s report on the cost of eating disorders, “Mental Health Services need to be joined up, comprehensive and responsive. The current pattern of fragmented provision with its silos of expertise concentrated in the in-patient treatment services so few people can access is no longer fit for purpose.”
After a six month wait followed by an unsuitable course of cognitive behavioural therapy, Anita paid for a private therapist and dietician to help her daughter Lucy. Their journey continues to be a difficult one. Anita is convinced that they missed their opportunity to stop the illness developing before Lucy’s behaviours became ingrained. “There is absolutely no question that if it had existed then, Orri would have been the first place we would have turned to. This type of treatment is the way forward, providing a viable alternative when hospitalisation isn’t the right choice,” she says.