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End the postcode lottery for people with eating disorders

Blog posted by: Heather Morrison Project Manager Mental Health Safety Improvement Programme, 24 February 2022.

The most deadly mental health condition is one which mainly affects young adults – and has a mortality rate of up to 20 per cent for those who are not treated.

It is anorexia nervosa, one of a range of eating disorders which typically affects girls in adolescence and early adulthood – though it also strikes young men and older men and women.

As a health professional who has worked as an advanced research practitioner in mental health acute settings I have seen the devastating effects of eating disorders, in all ages.

Now, in my role as project manager at the Innovation Agency I am helping trusts to adopt a solution called FREED which has been designed as an intervention in the first three years after diagnosis.

Intervening early is important because beyond those first few years there is less chance of success – and the damage to mental and physical health may be irreversible. This includes osteoporosis and in particular infertility, which could be tragic for a young person.

I am delighted that Mersey Care NHS Foundation Trust are now using FREED; and Cheshire and Wirral Partnership NHS Foundation Trust are about to start using it.

I am on a mission to spread FREED across the rest of the North West Coast region so that it is available to our local population wherever they live, ensuring equity of access. This is also happening in other parts of the country through our fellow Academic Health Science Networks.

report published by the eating disorders charity BEAT shows that adults with eating disorders in some parts of England have to wait, on average, more than ten times longer for treatment than in other areas and face a postcode lottery in the likelihood of a referral.

We need to end the postcode lottery.

We know that eating disorder sufferers are adept at hiding it; they might wear baggy clothes, hide their food – and over-exercise, out of sight. Also, they might present to a GP or other doctor with another mental health condition and the eating disorder is not spotted. But if medical professionals had more training about eating disorders, they would be more likely to recognise the signs.

A new campaign from BEAT is focussing on medical schools, calling on them to increase the time spent on the subject. They say less than two hours in a medical degree covers eating disorders, while it is not touched by one fifth of medical schools in the UK; this can’t be right.

FREED (First episode Rapid Early intervention for Eating Disorders) enables providers to start treatment within four weeks of referral to an eating disorder service. It emphasises early, pro-active engagement; early symptom change; family involvement; attention to the effects of eating disorders on the brain; attention to social media use; and attention to transitions such as leaving school, starting or finishing university, starting work; and ‘emerging adulthood’.

FREED was created at the South London and Maudsley NHS Foundation Trust and all AHSNs are backing its national spread and adoption. There’s good evidence behind it, as we can see that in initial evaluations and compared to treatment-as-usual processes, FREED:

  • Reduced waiting times by 32 per cent for assessment and 41 per cent for treatment
  • Reduced the proportion of patients who needed day-patient or inpatient care by 35 per cent
  • Helped 59 per cent of anorexia nervosa patients reach a healthy weight within 12 months of starting treatment, compared to 17 per cent of non-FREED treatment-as-usual patients.

I am proud to be able to help spread this intervention in our region, alongside my colleagues Alice Fletcher and Hannah Towler-Lord. If you would like to find out more, please get in touch.

Heather Morrison

Project Manager Mental Health Safety Improvement Programme


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