XenZone’s clinical director Dr Lynne Green, a consultant clinical psychologist, describes some of the issues associated with eating disorders and looks to digital as a way of giving young people with eating disorders greater personalisation, access and control over their treatment as part of an integrated care pathway.
Counterintuitive though it may sound, eating disorders are not just about food. Or being skinny. In reality, an eating disorder is a serious mental health issue characterised by problematic eating. Sufferers may restrict their eating or they may over eat; it’s common to see a combination of the two.
There is a host of complicated factors and thought processes that can fuel eating disorders. A need for control is often the driver. Controlled eating is typically a coping mechanism for other stressful or traumatic issues in a person’s life.
After twenty years in the NHS working primarily with eating disorder clients, I know that eating disorders can be incredibly complex and are frequently misunderstood. Unfortunately, they are also not uncommon.
According to the charity Beat, eating disorders currently affect around 1.25 million people in the UK, with this figure set to rise. Calls to the Beat helpline have been increasing: in 2017-18 the charity received 17,000 calls, while in 2018-19 the number rose sharply to 30,000.
There is no doubt that there are more people with eating difficulties presenting at eating disorder clinics or at GP surgeries, but whether that equates to an increase in prevalence rates is less clear.
As with all mental health issues, the more we know, the quicker we can make a diagnosis. Add to this the great work from anti-stigma campaigners and new Government targets and we can virtually guarantee an increase in apparent prevalence.
Greater NHS support has meant more people are in treatment once diagnosed, especially since 2015 when new standards were published. These stated that children and young people with an urgent eating disorder should receive treatment in one week and that those with ‘routine’ eating disorders should receive treatment within one month. The Government’s ambitious target is that by 2020, 95% of children and young people are treated in this timeframe.
While this initiative has certainly resulted in considerable improvement in the numbers of young people receiving early help, progress has stalled of late and more will need to be done if the 95% target is to be met.
The 2018 green paper on Transforming Children and Young People’s Mental Health also addressed children and young people’s eating disorders, emphasising early intervention and identification in schools. Measures in the recent NHS Long Term Plan (LTP) promise increased investment in children and young people’s eating disorder services and will extend current services so that people will continue to receive the same level of treatment until they are 25 (although where that leaves adults with eating disorders is currently open to question).
What the LTP also made clear, more broadly, is that there is a huge role for digital in enabling an integrated, personalised and more effective NHS.
I believe digital can make a hugely positive contribution, if done with an unstinting focus on the client and in partnership with existing specialist services.
We can expect to see a raft of digital mental health services over the next few years, enhancing the care already provided and offering different ways of accessing treatment. Our clinical team is already working on a digital eating disorder treatment package, which we will trial with some of our NHS partners over the coming months.
We anticipate such a service will not only address some of the engagement issues common to eating disorder services, but will also support a personalised approach while promoting choice – and thus a sense of control. Working closely with NHS specialist services is central to ensuring that our approach forms part of an integrated care pathway.
Digital lends itself to treating eating disorders for a whole host of reasons. One of the observations I have from many years working in more traditional face-to-face eating disorder services is that often, children don’t choose to come for help.
Usually they’re worried about what treatment will entail. Will it make them fat? Will they have to give up the control they have worked so hard to achieve?
Feeling ‘coerced’ into treatment can really threaten that sense of control which can reinforce the need to control eating – thus maintaining the eating disorder. This is understandably incredibly worrying for parents, friends, teachers and others who may be urging the child to get help.
Within Kooth, we see many people with eating difficulties. Because the service is anonymous and open to children and young people who log in of their own volition, we find that young people feel quite safe sharing some of their anxieties around their eating.
This gives our counsellors the opportunity to work with young people and motivate them to get the treatment they need.
We know that getting early help gives the best possible chance for recovery. Yet we also know that it can take a long time for an individual to recognise that they have an eating disorder, let alone overcome a reluctance to get the help they need. Sufferers are often good at covering it up so that it can be almost impossible for others to recognise the signs and offer help.
It critical then that we find new ways of enabling people to explore their eating behaviour and seek help if required at the earliest stage. We need to think about the interventions we’re offering but also, crucially, about the mode of intervention itself.
This eating disorder awareness week, I would urge commissioners, health providers, and the Government to consider the model of service delivery when thinking about eating disorder detection and treatment. The more we can make advice and help accessible, the more we can prevent eating disorders and help rising numbers of children and young people towards an earlier recovery.
Dr Lynne Green, Clinical Director, XenZone
See Dr Green’s video interview on eating disorders here