Eating disorder sufferers waiting six months for treatment after seeing GP

Government urged to 'snap out of complacent attitude' towards mental health after report reveals anorexia and bulimia sufferers face agonising waits for specialist treatment

Eating disorder sufferers visit GPs on average three times before they get a referral for a specialist assessment, with an average of 11 weeks between their first GP appointment and a referral, study shows (BSIP/UIG via Getty)

People suffering from eating disorders in England have to wait on average six months for treatment after seeing a GP, despite constant Government pledges to improve mental health services, new research shows.

Ministers have been accused of allowing vital support for anorexia and bulimia sufferers to “slip back” after it emerged they are now waiting more than double the recommended time between being referred to specialist services and starting treatment.

A survey of 1,478 people referred to treatment in the 10 years to 2017 reveals that sufferers visit GPs on average three times before they get a referral for a specialist assessment, with an average of 11 weeks between their first GP appointment and a referral.

The study, carried out by charity Beat, shows that once a referral is made, patients are waiting on average eight weeks for an assessment, and then another eight weeks for the treatment to begin — taking the total waiting time to half a year.

The findings indicate that the situation is significantly worse than previously thought, with analysis of NHS England figures earlier this year by Beat showing that just 10 per cent of patients had to wait longer than four weeks to start urgent treatment.

Guidelines from the National Institute for Health and Care Excellence (Nice) state that GPs should refer someone for specialist assessment immediately “if an eating disorder is suspected after an initial assessment”.

Treatment for children and young people should start within a maximum of four weeks from first contact with a designated healthcare professional for routine cases and within one week for urgent cases, the guidelines state.

Opposition politicians said the suffering of children and young people as a result of the delays was a “scandal” and urged the Tories to “snap out of their complacent attitude” towards mental health.

Norman Lamb, the Liberal Democrats’ health spokesperson, told The Independent: “Eating disorders can kill. What I find extraordinary is we voted for parity of esteem in 2012, given that this is a condition that can kill and beyond those who actually lose their lives are many who go through real trauma.

“It beggars belief that we’re still no further forward with this, and indeed that we might even be slipping back. There’s some evidence of an increased prevalence, but if that’s the case then the NHS should be seeking to meet that.

"It’s scandalous that children and young people are suffering as a result. We can’t and shouldn’t tolerate that.”

Barbara Keeley MP, Labour’s Shadow Cabinet Minister for Mental Health, said: “This report suggests that Tory Ministers need to snap out of their complacent attitude to the treatment of eating disorders.

“Today’s report follows troubling findings from NHS England about the delays faced by children and young people with eating disorders: it is yet more proof that warm words from the Tories haven’t been met with firm action to improve services in the community.

“It’s time for the Tories to follow Labour’s lead and pledge to invest more in mental health services for children and young people to ensure early intervention and to reduce delays in starting treatment."

The Government has said repeatedly that it is investing £1bn extra in mental health services per year, but the charities and politicians warn this falls short of what is needed and is often failing to reach the frontline.

In a speech in January, the Prime Minister said that for too long, mental illness had been “a hidden injustice in our country”, and pledged to transform the way mental health problems are dealt with “right across society”.

But despite Ms May’s pledges, mental health services have faced mounting pressures over funding amid rising demand, with vulnerable people facing “agonising waits” for treatment, often causing their mental health to deteriorate further.

Today's report shows that waiting times are longer for adults than children and adolescents, with sufferers aged 19 and over waiting significantly longer than under 19s.

The situation is also worse for men and boys, who make up between 10 and 20 per cent of people with anorexia or bulimia nervosa. They face an average wait of 28 weeks before their GP makes a referral for specialist assessment, compared with 10 weeks for female sufferers, the report shows.

There are also major delays in people with eating disorders seeking help, with an average of three and a half years between falling ill and starting treatment, according to the findings.

Beat warns that early intervention is “vital” if treatment for eating disorders is to be successful and sustained, citing that people treated within about three years of falling ill are more likely to have a quick recovery.

“After that period, the risk of severe and enduring illness rises significantly. Respondents to our survey waited on average for three-and-a-half years,” the report states.

“Many sufferers will therefore have sought help when their illness was highly treatable, but were then kept waiting until later, when likely outcomes were much less positive.”

One Anorexia sufferer, who does not wish to be named, went to a number of GPs who failed to diagnose her with the condition. It took three years for her to be diagnosed, and a further three months for her treatment to begin.

Her husband, who cares for her, said: “She had visited various GPs at home and university with tiredness and irregular periods. She was underweight, and her blood tests showed iron-deficiency anaemia and a low white blood cell count.

“Despite these findings being suggestive of an eating disorder, this was not explored. One GP requested a food diary, but it was never reviewed. Another advised that she was ‘a bit underweight’ and that she ‘just needed to eat more’.”

He explained how her mood then deteriorated and she was diagnosed with depression, and which point she was began counselling. Within a couple of sessions, her therapist identified disordered thoughts around body weight and food.

“These issues were reported to her GP and she was referred for treatment at an eating disorders clinic. It had taken three years for my wife's anorexia to be identified, and it would take another three months for her to receive the support she desperately needed,” he said.

“In the meantime, her restriction intensified. Our only option was to wait. Her rules around food became more rigid and her weight deteriorated further."

Dr Dominique Thompson, who was a GP representative on the recent NICE Eating Disorders Guidelines Development Committee, which produced the guidance the report refers to, told The Independent she was "sadly" not shocked by the findings and that training and resources must be increased to reduce delays.

“I agree with the recommendations proposed by Beat, but am sadly not shocked by the findings of the report. It clearly demonstrates that, as a society, we have a long way to go in helping people recognise the signs and symptoms of eating disorders in themselves of their families," she said.

"We also need to continue educating medical students and other health care professionals, not just GPs, in understanding that eating disorders are never ‘a phase’ and should always be taken seriously and referred at first presentation. This might go some way to mitigating the unacceptably long waits for specialist assessment, that occur in many parts of the country.

"Such waits will only be reduced when more specialist teams are trained and resources increased. Delays cost lives, and this is never more true than for eating disorders, which have the highest mortality of any psychiatric disorder."

In the report, Beat warns that the delays in referrals and treatment mean higher costs to the taxpayer, with the study suggesting those treated early cost the NHS much less. Previous research suggests eating disorders cost the NHS £4.6bn.

The research found that expensive inpatient care may be overused, with 29 per cent of respondents having received inpatient care while only 15 per cent had experienced day patient care and 11 per cent had experienced home treatment.

Chief executive of the charity, Andrew Radford, said the fact that there are such large delays between a sufferer’s symptoms emerging and their treatment started was “very concerning” and warned that the limited funding for treating eating disorders was not being spent efficiently.

“With pressure on the NHS budget money used for eating disorders must be spent efficiently. While inpatient treatment care is necessary in some cases, especially to save lives, intensive community care can be as effective in terms of outcomes and causes less disruption to day-to-day life,” Mr Radford said.

“By investing in early intervention and combining budgets for inpatient and outpatient treatment to free up savings from less use of hospital care we can help more people for the same money.”

In 2015 the Government introduced targets to reduce the time children in England spend waiting between being referred and starting treatment for eating disorders, alongside new funding of £30m a year.

But Beat said their research demonstrates that the time between symptoms emerging and a person beginning treatment is made up of a number of phases and much more is needed to fully address the problem.

An NHS England spokesperson said: “There are now 70 NHS community eating disorder services for children and young people covering the whole of England, backed £150m of investment.

"As a result, eight in ten young people now get care within four weeks, and three-quarters receive urgent treatment in a week, so progress is clearly being made."