Eating Disorders in the UK: Policies for Service Development and Training

With the collaboration of the Consumers' Association, the Eating Disorders Special Interest Group surveyed specialist eating disorder services for adults in the UK, as a follow-up to a previous survey in 1991 - Council Report CR14, Eating Disorders. We found that specialist services had increased in number since 1991 but that many areas remain without access to nearby specialist services. Many patients are sent long distances for specialist care, and adequate follow-up after such care is frequently impractical. Eating disorders are of high prevalence, representing a major source of morbidity, predominantly in young women, and the standardised mortality ratio of eating disorders is among the highest of all psychiatric disorders. There is a substantial evidence base for treatment of anorexia nervosa and bulimia nervosa, although research is urgently required to establish the most effective treatment for many groups of patients. We recommend the following action:

1. (a) For each area of the country, specialist services should be established, with one consultant psychiatrist per million population.

2. (b) These services should provide a combination of out-patient, in-patient and day patient services, with an appropriate range of therapeutic interventions.

3. (c) Expenditure on staffing should be approximately £1 per head of population.

4. (d) Steps should be taken to increase the number of consultant psychiatrists with special expertise in the assessment and treatment of eating disorders.

5. (e) Similar problems apply to the treatment of children and adolescents with eating disorders. Services for this group should be fully surveyed and recommendations developed for improving provision.

The Eating Disorders Special Interest Group has undertaken to develop criteria for specialist training in eating disorders in view of the particular mix of psychiatric, psychological, medical and nutritional problems faced by this severely ill group of patients. Our aim is to correct the unacceptable variation in care between different parts of the UK caused by unequal distribution of services.