The alarms should no longer be ignored: A Survey of the Demand, Capacity and Provision of Adult Community Eating Disorder Services in England and Scotland before COVID-19

Abstract

Aims and Methods: This national survey compared the demand and capacity of adult community eating disorder services (ACEDS) to NHSE Commissioning guidance. Results: Of 21 services approached in England and Scotland 13 responded (10.7 million total population). Between 2016/17 and 2019/20, the average referral rate increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), yet 46% of referrals were 18-25 years old.Most ACEDS had waiting lists and rationed access. Less than half of services were able to provide full medical monitoring, adapt treatment for co-morbidities, provide seamless transitions across the care pathway, or offer assertive outreach. ACEDS were 15% funded to meet demand, and to achieve parity with the CEDS-CYP would require an estimated £7 million in funding per million population.Clinical Implications: Even before the pandemic, ACEDS experienced a growing demand that exceeded its capacity. Given the increase in eating disorders since, substantial investment is required for ensuring safe and effective NHS services.

Autopsy of a failed trial part 1: A qualitative investigation of clinician's views on and experiences of the implementation of the DAISIES trial in UK‐based intensive eating disorder services

“…The specific systemic challenges encountered in the DAISIES trial demonstrate the profound impacts of an underfunded and overburdened system on research implementation, underscoring the need for investment into adult ED services in the UK as has previously been suggested regarding improving care (Viljoen et al, 2022). The results suggest that currently, conducting an RCT of the scope and magnitude of the DAISIES trial may not be possible within intensive adult ED services in the UK, and alternative research designs should be explored, such as naturalistic longitudinal studies.…”

“A true life changing event I will take with me on the journey of life”: Results from a mixed- method pilot study evaluating an emotion intervention for people with eating disorders

“…While our paper adds to this growing literature and could address high rates of relapse by focusing on the underlying emotion di culties which precede and maintain ED thoughts and behaviours (Henderson et al, 2021;Treasure et al, 2012;Warne et al, 2023), it also suggests that psychoeducation about emotions can be successfully conducted online in a cost-effective way. In the UK, demand for treatment far outstrips the capacity of adult ED services (Striegel Weissman & Rosselli, 2017; Viljoen et al, 2022). This leaves the majority of individuals with EDs to suffer long waiting times (Austin et al, 2021), which translate into worsening of symptoms (Vollert et al, 2019), higher total healthcare costs (Bothe et al, 2022), lower treatment uptake (Flynn et al, 2021), and less likelihood of responding positively to treatment (Austin et al, 2021;Fernández-Aranda et al, 2021).…”

We need your ideas—How to deliver developmentally informed treatment and care for emerging adults with eating disorders? A special European Eating Disorder Research issue about age transitions in eating disorders

“…In our own study, more than 30% of our former inpatients who had suffered from AN needed further support from an AED service (Herpertz‐Dahlmann & Gilsbach, 2022). As AEDS are usually much larger than CAEDS, these cases make up a much smaller percentage of referrals to adult services: A study of 13 AED services in the UK found that only about 4% of referrals were transitions from CAEDS even though nearly 50% of their referrals were emerging adults (age 18–25) (Viljoen et al., 2022).…”

“…In some countries, such as the UK, AEDS are substantially less well funded than CAEDS and therefore will not have the capacity to deliver treatments of similar intensity and in a timely fashion (Viljoen et al., 2022).…”

“…However, reports about the transition process are still scarce; moreover, a high level of anticipatory anxiety prior to any change could almost be seen as pathognomonic in AN. Nearly half of new referrals in AEDS are young people between the age of 18–25, thus most AEDS are very used to treating emerging adults (Viljoen et al., 2022). Moreover, in the UK, FREED, an evidence‐based service model and care pathway, designed with emerging adults in mind is being adopted nationally across AEDS in England (Richards, 2022).…”