Eating disorder services review: summary recommendations

Reasons for current particular importance – the impact of the Covid-19 pandemic

Eating disorders thrive on isolation. Services across the country have seen increased numbers of referrals of people with eating disorders since the start of the pandemic, following a brief downturn in presentations during the initial lockdown. We are seeing people present later and significantly more physically unwell. A number of papers on the impact of the Covid-19 pandemic on eating disorders have been published (3,4).

Scottish Child and Adolescent Mental Health Services (CAMHS) eating disorder leads have reported an unprecedented increase in the number and severity of children and young people presenting with eating disorders. In the seven health boards able to present data there has been a combined 86% increase in referrals between 2019 and 2020 (range 33% - 280%). This increase is within the context of smaller year on year increases in referrals. In addition, all leads report an increase in severity, illustrated by the 220% increase in paediatric admissions reported by two of the regional adolescent in-patient units. This increase in number and severity has also resulted in an increase in adolescent psychiatric admissions. The two regional units able to provide data report a combined 161% increase in eating disorder admissions between 2019 and 2020.

It is not just NHS services that have seen increased numbers. The UK eating disorder charity Beat has seen calls to its helpline from Scotland increase by 162% between April and October 2020.

As with other services, eating disorder services are rapidly adapting to the use of technology – there is potential to use telehealth to provide equitable access to specialist care regardless of location, but this needs to be balanced against the particular need in eating disorders to undertake physical monitoring and maintain the medical safety of patients.

At the same time as increased numbers and severity of presentations, in-patient services are having increasing difficulty in managing safe transitions from specialist in-patient to community treatment because of the ongoing Covid-19 restrictions. This includes restrictions on time out of the ward to build up time out safely, and restrictions on visitors such as family members who are crucial to supporting safe discharge. This means that some patients could be discharged with less support than previously, or with less preparation for discharge such as home leave, which may prolong admissions. Other patients may have to wait longer for admission or remain in hospital longer than prior to Covid. This has an impact on the ability of services to be able to admit patients requiring this level of intensive care and managing more severely unwell people in the community.