The staggering cost of eating disorders in England

If ever there was a reason to emphasise the desperate need for early intervention, greater awareness and compulsory education on the subject of eating disorders, this is it.

Eating disorders are the most fatal of any mental illness and over 1.6million people in the UK are affected. They cost lives, relationships, jobs and dignity, but they also cost this country a hell of a lot of money.

Today, Beat has published a report which found that the overall cost of eating disorders (including those to the NHS, employers and employees) to the English economy is a staggering £1.25billion per year.

The report, by economist John Henderson, reveals overall healthcare costs estimated at £80-£100m, costs of reduced GDP up to £2.9bn, and costs of reduced length of life and health up to £6.6bn.

I am writing this, already visualising comments suggesting where the money could be better spent, telling me there are people who are more deserving and adding to that old myth that people with eating disorders need to get a grip, grab a burger and go on their merry way. If that’s how you feel, fine; even as somebody who has been in the grip of anorexia and bulimia and has been a part of that drain on NHS resources, at times (regrettably) not even complying with the rules set by those who were caring for me, I understand your anger and/or disbelief.

I agree that this cost is too high, that eating disorders shouldn’t be this expensive to treat and that as our NHS struggles through cuts, strains and staff shortages, we simply can’t afford to let this one go. I don’t agree that eating disorder sufferers have any less right to gain access to treatment than those who have any other illness, but I am beyond angry that we haven’t learnt already that we, as a country, are not tackling the problem anywhere near efficiently enough. It’s time for action.

Put extremely simply, if eating disorders were picked up on and treated as early as possible, the cost would reduce dramatically. Of course, if it was that simple, some clever Dick would have surely said something, done something. But really, even if we break this down, it isn’t rocket science; if teachers, parents, sports coaches, employers and even friends knew how to spot the early signs of an eating disorder and feel confident in approaching the subject rather than pussyfooting around it, whispering and worrying in silence, then we’d be much closer to creating an environment in which it’s more acceptable, less scary to talk about.

Speaking out about eating disorders is never easy, for either party. The person with the eating disorder is likely to be trying to hide it as best they can; it’s their secret, their weapon and anyone suggesting they need treatment must be out of their mind – they’re nowhere near ‘ill enough’ to warrant that! They will do anything they can to avoid ‘that conversation’. Like magnets repelling. Those harbouring worries often say they ‘tread on eggshells’ when it comes to bringing up the subject, scared they’ll be snapped at (and probably right, too). As difficult as it is, though, the longer we leave it, the harder it gets. We may snap, but it’s more than likely we’ll end up thanking, and possibly even owing our lives to those who dare confront us.

The next step is seeking treatment, whether it’s being dragged kicking and screaming into the doctor’s surgery, taking a deep breath and heading there alone, or somewhere in the middle, reluctantly seeing a GP to half-heartedly admit you ‘may have a slight problem’ simply to keep the worrieds quiet (for a while).

This appointment could be life-changing. This appointment holds more meaning than most people will ever know. This appointment could mean an eating disorder is nipped in the bud or it could be the start of a struggle which could go on for years. A GP who understands the seriousness of eating disorders, who recognises the potential outcomes of their actions at that first meeting and is compassionate and sensitive would do the right thing by assessing physical and mental risks and offering appropriate follow-up – be it counselling, specialist services or regular GP appointments. The most important thing is that the patient feels that they were taken seriously – which far too often, is not the case.

GP consultations on anorexia and bulimia cost £4.2m annually, so we need to get it right. Spending money on education, awareness and training would go a long way in decreasing the amount spent further down the line.

I have lost count of the number of times I have heard people say that the first time they spoke to a GP about their eating disorder was an absolute disaster. Some were told it was “just a phase”, some ignored as it’s not something that happens to men/older women/Afro-Caribbeans and an unbelievable amount of people say they were made to feel that they were not “ill enough”.

From my own experience, I have come across at least three medical professionals who have made me feel unworthy of taking up five minutes of their precious time. After telling one that I had been starving myself and making myself sick, aged around 15 or 16, I was told that as long as I was still menstruating, I was fine. Absolute rubbish – years later, my consultant psychiatrist told me that she had worked with patients with a BMI of 11 and were still having periods. Another GP told me that, despite low blood pressure, heart palpitations and frequent dizzy spells/blackouts, my BMI (though dangerously low) was not low enough for any kind of treatment. The worst, at a time when I was at University in Aberystwyth and spiralling out of control, listened to all I had to say, my plea for help, and simply said “Well I’m not going to lose any sleep over you.”

This is not acceptable. Not many people with eating disorders can find it in themselves to ever even ask for help and it takes a hell of a lot of guts to do so. Your brain is constantly telling you not to give in; asking for help is weak, getting help is giving up. You’re never ill enough, never thin enough and never deserving enough to take up space, time or money. For logic to overcome that, for someone to reach out when they’re consumed with an illness that tells them not to, to then be told something which confirms those thoughts is simply outrageous.

Nobody responds well to being knocked back. People with eating disorders are highly likely to use that doctor’s comment or put-down as fuel. It will make them feel more invincible whilst at the same time more desperate than ever to prove that they are sick, fragile, frail and in need of help. That one appointment is a critical catalyst in one direction or the other.

After a few knock backs, maybe change GP. You get lucky, someone who understands! By then, you’re really ill, weak, tired, pale; a zombie. They refer you to a specialised unit. Waiting list: 12 months. You get worse still and you’re either sectioned, or your eating disorder eats more into your mind, doubling the length of your stay, when you finally get there.

The average cost of an inpatient bed for treatment of an eating disorder is £510 per day. I have been hospitalised twice. The first time: three months, followed by a year of outpatient treatment. The second: nine months. I’m currently two sessions away from finishing another 24-sessions with a counsellor. Hopefully, that’ll be it.

I can hardly even stand the thought of adding up the cost of my own treatment. In all honesty, it makes me feel physically sick knowing that it is probably somewhere over £10,000. I cannot justify that and I never could. Knowing how much it was costing the NHS was one of the things that forced me to work my arse off during my time in hospital. I, like many inpatients, constantly felt that there were people out there who needed that bed more than me, who were closer to death’s door and could be saved if I wasn’t taking it up so selfishly.

If I was reading this as someone who has never directly experienced an eating disorder, I think I would be appalled. I get that.

But what if my school nurse or deputy head had pushed harder to encourage me to visit my GP? What if that GP hadn’t made that ridiculous comment about my periods? What if my tutors at college had said something instead of offering me water after I collapsed of exhaustion simply through rushing across a car park? What if the west coast of Wales actually had a specialised eating disorder eating disorders service? What if that psychiatrist they sent me to hadn’t made me feel so inadequate?

I’ll never know. ‘What ifs’ are just that. Things could have been different, but who’s to know? What I am sure of though, is that there were certainly a decent number of occasions where just a little understanding and knowledge could have had a huge impact.

Eating disorders are so complex, but the way I see it, beneath the physical signs and behaviours, a mass of negative thoughts and feelings are what fuel the illness. The longer we leave it, the deeper they’ll become ingrained into our brains, the more time they’ll take up and the less we’ll be able to concentrate on anything but self-deprecation.

Recovery is the picking apart of this mess. Recovery is the process of un-doing. The earlier we do that, the quicker we are to step in and intervene and interrupt that devastating illness, the better (and cheaper).

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• muggerbe

  Take heart. I’ve been battling anorexia for years. So far I am well ahead on points.

• DarHam

  As someone who battled anorexia and then bulimia for decades, I agree that doctors and the community in general need to be better educated to help sufferers get the treatment needed to battle eating disorders, which, to me, are the only way one can feel in control when life events make one feel out of control and unable to cope. I live in the U.S., where mental health disorders are typically minimally covered, so seeking treatment is not only difficult emotionally, but it takes the toll on ones finances as well. Even today, I go without seeing my psychologist because it is too expensive. Help is out there, but there are so many hurdles to get it and so many suffer from this disease that is difficult to reign in. There is no cure, but it can be dealt with to keep it in check. Good luck to you and all those who continue to battle eating disorders. Some days are easier than others!

• http://twitter.com/jennifermckean Jennifer McKean

  Utter tosh. Stop worrying about what non-sufferers would think about this statistic. Are you more concerned about those getting the treatment they need and not being “knocked back”, or the state saving money? We know anorexia isn’t a choice. When a sufferer is going hungry every day, it’s not because they’re feeling “physically sick” about how much the NHS would pay to treat them. In my opinion, the NHS should always be paying more to help those being marginalised for an illness still prejudiced in this day and age. We pay for the NHS and it’s their duty to give everyone the highest standard of care, equally.

  The main reason we should intervene early in such a terrible mental illness should never be to simply save money – How about saving lives?

• http://twitter.com/E_M_Cooper Emma Cooper

  I think you make some really good points about the importance of early intervention, how greater awareness can be vital in stopping someone sliding further into their eating disorder, and the power of how a person is responded to when they first disclose. I became ill in high school, and had a very aware PE teacher, who tried several times to get through my barrier of resistance that I was ‘fine’. She didn’t manage to, but the fact that she cared enough to keep, trying made an impact on me. Eating disorder services are so sparse in many places in the UK. To me, that is where the real work needs to be focused – provision of accessible and high quality outpatient and day treatment programmes, so that people can be helped before their bmi is at rock bottom, before where thoughts and behaviours have become entrenched. I think you’re giving back plenty in raising awareness of these issues, and anyone who understands anything about ed’s would never begrudge you (or anyone else) the cost of your treatment.

• http://twitter.com/sarah_robbo Sare

  So many great points, I don’t know where to start. Like you, I dread to think how much my recovery has cost in total. After 3 separate outpatient admissions, and like yourself, a lot in which I ignored and went against the advice I was given, effectively throwing away precious money, I really won’t be adding it up any time soon. However, I do believe that the doctors who told me I just had control and anxiety issues, the doctors who made me feel too fat to have anorexia, the doctors who told me over and over again that my BMI was fine, wasted NHS money too. It crushed me, it made me feel I wasn’t ill enough. If those doctors at the age of 13, 17 and just before my 25th Birthday has listened, then maybe I wouldn’t be still costing the NHS money now? I am currently in my 13 month of DP/IP treatment – 3 days a week, as well as paying for private psychotherapy too. I didnt choose to have anorexia, I didn’t chose to lose my life, job and friends with the kgs, it wasn’t a lifestyle thing, but I did chose to walk in to the doctors and open up and tell them. I did chose to break away, so maybe Drs, headteachers, coaches and other people should chose to learn more about eating disorders.

  I am not sure I make my point here, but I agree, that better education and understanding of all EDs would not only save money in a saturated budget, but save lives.

• Maria Ashot

  Brave girl, thank you for writing this. It is too true! Being superskinny has been so overpromoted by the fashion industry that too many people simply do not realise being underweight can be a sign of severe distress (rather than some great achievement). Much greater concern for the well-being of humans is needed than is currently on offer. Wise up & reach out!

• http://www.facebook.com/people/Ele-Booth/511207104 Ele Booth

  I had a friend who suffered from anorexia at age 12, which I would now say was a child who “starved themselves”. The person in the article DID understand they had a problem, and sought medical assistance, at which point they were rejected by doctors and other medical staff, and told they were fine. Of course it is fundamental in treatment for a patient to understand they are ill and are suffering from an illness, but one of the major factors in convincing them of this is having people around them who can diagnose this, and having doctors ready to treat patients who have come willingly to seek assistance. This article was about early recognition and treatment of patients before they get to the stage where they need “sectioning”, and 24 hour care. Surely you must agree this is better for everyone involved, both the patients and staff, and for funding for the NHS?

• VicTheBrit

  I would hardly describe a 12 year old as a “child” given that puberty sets in around the age of 10 or 11 these days – even “pre-teen” doesn’t fit the bill.

• http://www.facebook.com/katie.williams.184007 Katie Williams

  I agree. Earlier intervention would help massively. The number of people who can’t get any help at all until they require hospitalisation and medical stabilisation (which must cost a lot of money) is awful. Surely it costs less to give someone 12 sessions of CBT before they’re on deaths door than it does to sort their bloods, kidneys, heart, bones, refeed them and all the rest?