Specialist eating disorders unit in Northern Ireland isn’t viable, say experts on front line
Eating disorder specialists in Belfast have spoken out about the difficulties in providing care for hundreds of patients each year.
The debate around NHS services for eating disorders came into focus again last month after the death of Co Down woman Sophie Bridges at 21 after struggling with bulimia for years.
Her family and others with eating disorders expressed their frustrations at the time about available care, including waiting too long for referrals. Calls were made for a dedicated eating disorder unit in Northern Ireland.
Giving their views at the Beechcroft Child and Mental Health Service (CAMHS) in Belfast was Billie Hughes, lead nurse for CAMHS in the Belfast and South Eastern Trusts, and Edel Gilchrist, team leader clinical nurse specialist for the eating disorder youth service.
"Something we're hearing more of is 'it's not cool to eat at school'," said Ms Gilchrist.
"A big challenge we also face is young people coming to us when they're already very ill, so there's only a limited amount of things we can do before we have to implement medical admission."
Ms Hughes added: "So many children don't like eating in schools.
"That's partly a fear of using school toilets and not wanting to eat in front of their friends."
With factors like bullying and pressure to achieve, she said referring more children for treatment at an earlier stage wasn't always helpful.
"It's hard to strike a balance, we don't want to medicalise all children.
"Sometimes it is about education and working through the issues of bullying and primary intervention, as eating disorder treatment is a third level intervention.
"More education in schools would help, big time."
Treatment for eating disorders here is divided into child and adult services, with more than 700 people referred between April 2017 and March of this year.
The Belfast and South Eastern Health Trusts treated 218 people for eating disorders in this period.
This figure has remained largely static for three years.
The Northern Trust treated 133 severe cases in the same period, 60 young people and 73 adults.
The Southern Trust reported 197 referrals, up from 141 the previous year.
The Western Trust had 188 referrals, 57 young people and 131 adults.
Both Ms Hughes and Ms Gilchrist maintain that a specialist eating disorder unit here would not be suitable.
"There was a lot of pressure on the last Health Minister for that but it just isn't viable with our small population," said the former. "With our community teams, home treatment has the best success rate."
A perception remains with some sufferers that they can only access the best treatment in England.
"Services in England are not perfect by any stretch, there's a lot of private providers. There's long waiting lists for NHS beds, it's not as if they have it sussed, and they do struggle," Ms Hughes added.
"I think there's only around four (beds) in the Belfast Trust area and just one under 18 in the last two years."
The impact of social media, the women said, often had a toxic, and even competitive, effect on young people.
"It can motivate people to try and become a 'better anorexic', as it can be quite a competitive illness," said Ms Hughes.
She admits not every patient is satisfied.
"We've had complaints, people have been unhappy," she said.
"We try our best to deliver an evidence-based service but some people may not engage with it or feel it meets their needs."
The best first step, Ms Gilchrist added, was not to suffer in silence.
"Talk to somebody you feel is trustworthy and genuine, whether that's a teacher, parent or a school nurse," she said.
For further information on eating disorder services in Northern Ireland, visit familysupportni.gov.uk.