Medics trivialise anorexia and girls like Averil pay the price

NOTHING that anyone can say or do will bring Averil hart back. All her parents wanted was answers, but it has taken them years of tireless campaigning to get to the bottom of what really happened to her and who is to blame for her tragic death.

As reported yesterday, the 19-yearold student, who suffered from anorexia, was found unconscious on the floor of her university flat after she became so weak she couldn’t stand.

Only four months previously she had been discharged from hospital, but her case was not followed up properly and her weight plummeted. A catalogue of failings from every NHS organisation involved in her care led to her death in 2012. The Parliamentary and health Service Ombudsman has now said that these failings were symptomatic of wider NHS failings in the treatment of people with eating disorders and needed ‘urgent national attention’.

As a specialist in eating disorders, I completely agree. The way that those with eating disorders are treated in the NHS is nothing short of a scandal.

The problem is eating disorders are one of the last areas in mental health where people still feel at liberty to dismiss it as ‘all in the mind’.

These days, no one would dare say to someone with depression that they should ‘ pull their socks up’, but I’ve heard doctors and nurses say to someone with anorexia that they should ‘just eat’, or to stop being so vain. It’s considered something that silly young girls do to get attention, driven by vanity and narcissism.

This couldn’t be further from the truth. Anorexia is not about vanity: quite the opposite. Many of the patients feel profoundly disgusted by their bodies and feel they don’t deserve to eat.

FOR many, it’s not even about how they look; it’s about the sense of control and mastery they get from restricting their food intake.

The nature of an eating disorder means that many patients don’t want treatment or will avoid contact with services. We have to be very proactive — and this requires a lot of energy.

The condition also means many don’t see themselves as sick or don’t feel they’re deserving of treatment. Many have very low levels of self-esteem and entitlement, and it’s all too easy for this group of patients to be ignored and pushed to the margins. I’ve had patients told by GPs and doctors in A&e that they ‘didn’t look very anorexic’.

GPs will often not bother to do the blood tests I request to assess how damaged their organs are and to check that patients are not physically deteriorating.

Despite the high risk of heart attacks in this patient group, heart tracings are not done and scans are not ordered. GPs also dismiss the patients when they go to see them about physical health concerns — chest or abdominal pains, for example — attributing everything to the eating disorder.

Other mental health services, such as those dealing with depression, anxiety or personality disorder, are reluctant to get involved if the person has an eating disorder, even though we know that eating disorders often go hand in hand with these other mental health problems.

There is no doubt that the eating disorder service failed Averil. These services are in dire straits and I know Averil’s story is far from unique. This area of medicine is highly specialist, requiring a depth and breadth of knowledge — both psychiatric and medical — that few have.

The vast majority of doctors go through their entire training with no experience of eating disorder services — and this is true, too, even for many working in mental health. There are extraordinary levels of ignorance about the condition among medical professionals and, because of this, few people choose to specialise in it.

AT The unit where I work, we have been searching for appropriately-qualified staff not just for months, but for years. They simply aren’t there.

As a result, many services downgrade what they offer. There are no doctors, so instead they are run by psychologists and nurses, who are often very good and highly skilled, but lack the medical background needed to ensure that patients are physically safe. One in five people with an eating disorder dies from an eating disorder. It’s a shocking statistic that preys on my mind — and when I go to work a part of me dreads looking at my emails for fear that a patient has died.

The mortality rates are similar to brain tumours. Now imagine a service for patients with brain tumours being run without doctors. It would never happen.

And to compound the tragedy, we only know about Averil’s case because her parents fought tirelessly for answers, while some of the NHS organisations involved tried to hinder the investigation into their conduct.

Let’s not beat around the bush: Averil was allowed to starve to death. This is a total dereliction of duty for those whose job it was to save her.

It is a tragedy that it took her death for the shortcomings of services for eating disorder patients to be discussed, but also a tragedy that today there are patients out there who still won’t get the care they need.