By Judy Krasna, F.E.A.S.T. Executive Director
Last week, I attended an impressive eating disorders conference in the UK. In her opening remarks, Dr. Agnes Ayton talked about the need for “therapeutic optimism” to counter the negativity and the glaring deficits in the system.
I was struck by how pretty much every speaker mentioned the failings of the treatment system in the UK. There was a palpable feeling of distress, frustration, and futility, like providers are treating eating disorders with one hand tied behind their backs due to the limitations, constraints, and deficiencies of the system. As someone who runs a global eating disorders organization, I can unfortunately assure you that this is not exclusively a UK issue, not by a longshot.
I was also struck by how every single speaker was genuinely passionate about treating eating disorders and by how pained they were by the current situation. The questions from the audience reflected this as well. And I was extremely impressed by the constant mention of including parents and families in treatment, which was truly music to my ears. Though the system may be getting it wrong, these providers are clearly getting it right.
There was a lot of talk about how covid crippled an already overtaxed system. While this is undoubtedly legitimate, I am concerned that somehow covid can potentially be used as an excuse to somehow justify the dysfunction.
One of the most glaring issues was the inability to be treated for eating disorders and comorbidity simultaneously. According to Dr. Mima Simic, depression is present in 50% of patients with eating disorders. We know that eating disorders are a risk factor for suicide. And yet, the system—pretty much every system in every country—seems to ignore these facts and not offer treatment which spans the eating disorder and the comorbidity, taking full recovery off the table for so many people. I find this personally heartbreaking because we experienced it first-hand.
To make matters even worse, the eating disorders sector is losing its workforce because it’s too hard to treat eating disorders. No one wants to manage the risky cases. Please excuse the cynicism, but it must be nice to have the luxury to walk away. It’s certainly not an option for us as parents.
One of the statistics that was mentioned at the conference is that the re-admission rate for inpatient treatment is 40-50%. That tracks with other countries throughout the world. It also means that treatment is failing miserably, despite what I can only assume are the best efforts of providers.
Are eating disorders difficult to treat? Obviously they are. But the thing is, they are treatable. I heard that at the conference as well. So, they are treatable illnesses, but they are not being successfully treated. What would be considered intolerable in other medical fields is somehow accepted in eating disorders treatment.
How do we improve the success rates of eating disorder treatment? That’s the million dollar (or pound) question.
Years ago, I attended the International Conference on Eating Disorders, and the keynote speaker was Dr. Vikram Patel. He gave a fascinating presentation about administering mental health treatment in low-resource areas. One of the ideas that he mentioned was “task shifting,” which according to the WHO is defined as shifting service delivery of specific tasks from professionals with higher qualifications to those with fewer qualifications or creating a new cadre with specific training. Dr. Patel was quoted in this paper as saying, “It is meant to alleviate the heavy workload of specialists and to ensure that those with no access to specialists have a means of accessing some level of mental health services.”
Dr. Patel was referring to mental health treatment in India, but sadly I think that eating disorders treatment in many other countries qualifies as low resource.
As Dr. Patel was speaking, a few things occurred to me. One is that it seems to me that FBT (Family Based treatment) is a form of task shifting. Parents are trained as partners in treatment, to handle specific meal-based tasks. Evidence has proven that this is effective.
As I was sitting in another session during the same conference about dealing with suicidality in eating disorder patients, I started thinking that parents can be trained in DBT so that they can help manage their child’s distress, suicidal ideation, self-harm, and other extreme behaviors. Is this ideal? No, it’s not. But I think it’s viable.
Task shifting is something that I believe should be considered to alleviate the burden on the system. It can be used in different contexts. And I think it can work.
I am confident that there are solutions to the inadequacies of any system. I am hopeful that improvement will happen. I am positive that people with lived experience must be included in creating this change. I see true collaboration in the UK between experts by profession and experts by experience. There is a real sense of “we’re all in this together” and genuine partnership.
Dr. Agnes Ayton made an interesting observation. She said that if you don’t have therapeutic optimism, you reinforce eating disorder psychopathology. I found that to be a very strong idea.
Eating disorders are not hopeless. Our kids are not hopeless. Treatment in the UK is not hopeless. In fact, some of the research presented at the conference was very encouraging. There is impactful work being done. There are so many clinicians and researchers out there determined to make the eating disorders field better. They are, and they will.
I truly hope that the eating disorder field embraces this therapeutic optimism. It will shape the way eating disorders are treated. It will provide the energy to persevere and the impetus to fix what is broken. It will reduce burnout and increase motivation. It can be key in improving outcomes.
I have full faith in UK clinicians and in our UK FEAST ambassadors to find ways together to make their system more effective and to overcome the significant barriers that stand in the way of better treatment. It can be done, in the UK, and across the globe. A little therapeutic optimism can go a long way to making this happen.