According to the latest guidance from the Royal College of Psychiatrists, since the pandemic, referrals into eating disorder services have increased. Sadly, we are also seeing an increased number of inquests relating to deaths of patients affected by eating disorders. Common themes in the cases we have seen include:-
- A lack of awareness and understanding of eating disorders, and
- A lack of availability of eating disorder specialists involved in inpatient and outpatient care.
In response, the Royal College of Psychiatrists recently reformed the ‘MARSIPAN’ guidance and replaced it with the Medical Emergencies in Eating Disorders Guidance (MEED) to support and educate primary and secondary care workers of the latest trends in eating disorder management.
Gap in awareness and engagement
In recent inquests, a key theme found by coroners is a lack of awareness within the primary care setting on how to treat eating disorder cases. For example, a GP will carry out regular physical monitoring checks once a patient is discharged from the local eating disorder service, however, these are often misinterpreted. The blood parameters seem normal, when in actual fact the patient is at high risk of relapse.
Another key theme is that GP referrals into services are often completed incorrectly, causing an avoidable delay in admission into services. Namely, referrals are not submitted early enough, because the warning signs which may have been picked up by a specialist, were not acknowledged in the primary setting. Again, coroners have identified a gap between knowledge and understanding of eating disorders in the primary and secondary care settings, with GPs stating they would benefit from a closer interaction with local specialist eating disorder services.
Involvement of specialists
From an inpatient perspective, recent inquests reveal an absence of eating disorder specialists, consultants, dieticians, and eating disorder specialist wards. The benefit of having these specialists is the ability to identify early warning signs of an eating disorder, notice high-risk presentations, and implement accurate monitoring.
Additionally, eating disorder patients frequently decline to engage with services or adhere to treatments. As a result, the patient is often discharged from eating disorder services and released back into the community without regular physical monitoring, during which time the eating disorder condition deteriorates. This lack of engagement can be misinterpreted as an unwillingness to engage, rather than a symptom of eating disorder. Patients will often decline to engage with services or present as not requiring intervention. This can then be viewed as the patient either rejecting support or recovering, when a trained eye would identify the warning signs of relapse.
Following a recent Prevention of Future Deaths Report, and in an attempt to educate care workers, a NHS Trust created new position of ‘Consultant Dietician’. This post is dedicated to provide support and advice to local GPs faced with eating disorder cases. It is hoped that, with this specialist advice and support to hand, local GPs will be able to quickly access specialist guidance, improve their own awareness of eating disorders and avoid future scenarios in which they cannot recognise eating disorder warning signs, or complete an early referral into eating disorder services.
Latest guidance from the Royal College of Psychiatrists
In recognition of the growing number of eating disorder inquests, the MARSIPAN guidance was replaced with MEED in 2022, which aims to provide clinicians with information to help diagnose eating disorders early on. Crucially, MEED also expands the scope of eating disorders by providing guidance on bulimia nervosa and binge-eating disorder, highlighting the previous disparity in awareness on eating disorders other than anorexia nervosa.
The MEED guidance also affirms the importance of having experienced, eating disorder specialists in a patient’s care team. The guidance reiterated the role of primary carers in eating disorder cases: to regularly monitor eating disorder patients and refer early into services. Furthermore, the MEED guidance contains a checklist of things to look for when a clinician is drafting or triaging a referral, predominately, nutrition status, eating behaviours, electrocardiograms, Body Mass Indexes and blood tests.
To conclude, outcomes from the latest eating disorder inquests strongly correlates with the most recent MEED guidance – the crucial and early involvement of eating disorder specialists, facilitated by a swift referral by the GP into services. It is vital that primary and secondary care workers reflect on the MEED guidance to implement new strategies to get ahead of the increasing figures of eating disorder cases.
Inquests of this nature tend to be complex and require careful handling. For more information or advice on a specific case please contact our Inquests team.
For further information, please contact:
Kate Fawell-Comley, Hill Dickinson
kate.fawell-comley@hilldickinson.com
