The staggering cost of eating disorders in England
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).Tagged in: anorexia, beat, bulimia, eating disorders, health, John Henderson, mental health, nhs
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