Martin Daly: Hidden Eating Disorders and the Case for Coordinated Care
Martin Daly highlighted a large hidden group of people with eating disorders who do not present to GPs or services and urged better coordination of care, including registers of admissions and designated general physicians to manage transitions. He warned that social media is worsening the problem, many patients are told they are "not sick enough," and deaths should be recorded as caused by an eating disorder rather than only by associated complications.
Hidden sufferers and barriers to care
Martin Daly described a substantial number of people with eating disorders who never present to anyone, including their GP, and who may only be suspected by family members because of over-exercising or strict dieting. He said social media plays a significant role, and noted that many people living with an eating disorder have little insight while some families access supports without the person being engaged in treatment.
Failures in frontline assessment and admission
He recounted that some patients are told by GPs that "your bloods are fine" and are offered no further help, while others attending A&E are told they are "not sick enough" to be admitted. Daly said that, as a result, some people feel pressured to get sicker to receive care, and that admissions can be sought only at extremely low BMIs such as 14.
Need for coordinated hospital and mental health transitions
Daly raised concerns about young people with complex medical needs who move from general paediatric care into adulthood and lose a coordinated, holistic hospital service. He proposed a register of known admissions and a designated general physician in hospitals to coordinate care and manage the transition from paediatrics to general medical services, and urged similar transition planning from CAMS to adult mental health services.
Recording of deaths and long-term costs
He argued that deaths resulting from eating disorders must be recorded as such rather than listed under associated complications, and warned of the heavy mental, physical and economic costs to families and the state. Daly pointed to long-term physical effects that can persist into someone’s 30s when the disorder began decades earlier.
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Thank you. Deputy Dilley. I think following on from Deputy Clark as well, I think you would agree that there is a large hidden group of people who have eating disorder who never present to anyone. There's a suspect, isn't it? And don't even present to their GPs. There may be suspicions within their family that there's an issue over-exercising, controlling their diets, and unfortunately social media is playing a huge role in that as well. I'd like to comment on that. And then I want to return again to this idea, and it's just not this service. It's, again, children with complex medical needs who turn into adulthood or under general paediatricians, for example, and once they turn into adulthood, they end up with no one taking charge of their holistic care in a hospital setting. I mean, the idea of physicians who are generalists, unfortunately we've gone down the silo, so everyone is super specialised. But sometimes, you know, people living with anorexia nervosa have significant medical issues and die from significant medical issues, which is heart failure. that we have designated people a register of the known admissions and a designated general physician in a hospital that takes, coordinates their care, allows for the transition from paediatrics to general medical services, and also the same would happen in the mental health services from CAMS to adult. I'd like what you'd think about that. Plenty. If you look at our stats, there's a proportion of people who are not in any form of treatment, who have not accessed their GP, who are not engaged in any treatment and are just using our supports. And there are lots of families whose person with an eating disorder is also not engaged in any treatment, and so the families are just accessing supports for themselves. So absolutely, there's a huge, there is that hidden number of people. They're the lucky ones because there is some self-awareness because, as we know, the person who's living with this often has very little insight into their issue. Yeah. And equally so, there is that portion that go to their GP and their GP will say, your bloods are fine, there's nothing I can do. That's my experience two months ago. And there's also the patients who are brought into hospital, into A&E, and told, you're not sick enough, you need to go home. And so what that eating disorder voice is saying to these people is, you're not sick enough, you've got to get sicker, and then they look after you. And some of these people are, and we've seen it on our groups, they're crying out to go in for support and help. And they're not getting it. And to get an admission, I mean, we're talking about a BMI 14, like someone who's literally in danger of dying. And I think the other point that is very important to be recorded going forward is those that die from an eating disorder that it's recorded as an eating disorder and not used a complication that is associated with it. I noted that in your presentation there, and I agree with you. I think... The result of doing nothing is just a huge cost to families. It's a huge cost to the state. There's a mental, emotional and physical and economic cost to everybody concerned, families and the state, because the knock-on effect of people we know who are in their 30s, and the physical effects of the eating disorder that started for them 20 years before is horrendous. Yeah, pretty quick, I think.
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