7 ms·

In the eating disorder unit

85 points by fern12 9y ago

pjc50 9y ago
It's desperately under-funded: "The hospital itself was old and seemed to be in the process of being shut down around us. Half the wards were empty, including the one opposite – a strange sight to those of us who had nearly died waiting for a bed. In winter, when it was too cold to be taken to ‘the bench’, we would instead be taken down another, deserted corridor, to sit for 15 minutes in a disused waiting room. When the five-bed rehabilitation house for patients leaving the inpatient unit was threatened with closure, doctors started to send patients there at a lower weight than advised, to secure its funding. Funding applications had to be made for each patient every two weeks, and I remember at least one patient being discharged suddenly and prematurely, because she had reached a weight beyond which her Primary Care Trust wouldn’t pay for treatment. Others, including me, had to prove that we weren’t ‘chronic’ cases and therefore worth funding. "
d33 9y ago
> (...) the overstretched staff didn’t have much time to support me, and I was often left crying on my own. Sometimes my tears were taken as evidence of ‘non-compliance’. This, on its own, is already outrageous. What could lead to forming this kind of attitude?
- DanBC 9y ago
  Eating disorder is often comorbid with what's called "personality disorder" (usually what's called borderline PD). People with that label experience significant levels of stigma and discrimination from health workers, including mental health workers.
  - yipopov 9y ago
    That said, it should not be underestimated what an immense strain those people are on mental health workers. I wonder how much time those institutions dedicate to debriefing their own staff, I think that would make a big difference in how the patients are treated as well.
- thirdpoliceman 9y ago
  Mostly I think its just exhaustion and desensitization. I spent a year in a child unit. Pretty much anything you do can be labeled as non-compliance. Staff got very callous out of necessity. Sometimes there were 20+ restraints in a day and once someone has spent hours restraining screaming/violent/suicidal kids, they don't have any patience or sympathy for someone crying in the corner. And basically anything you do can be labelled as non-compliance. I remember a nurse waking me up in the middle of the night to ask me to look at some paperwork. When I got pissed off (as anyone would) she put in the handover that I was being non-compliant. It's shitty but it seems to be a common attitude. Her experience isn't particularly extreme.
jostmey 9y ago
Quote: "The advice was not encouraging." What would be encouraging to hear?
- zelos 9y ago
  "There's another 30 hours of counseling and therapy available" (which at ~£50/hr is presumably a lot cheaper than a stay in ICU)
  - frabcus 9y ago
    This is what drives me mad. Professional therapy that actually works and can help patients solve the underlying self-esteem issues from childhood isn't easily available to people suffering from anorexia. More generally, I would argue that if we increased tax and gave everyone as much therapy as they need, the money would be saved by reducing sick days for businesses, reducing other healthcare costs, and increasing productivity of mental well people. I think we should do it even if it wouldn't save that money, but intuitively it feels like it would, so it makes not doing it even crazier... Does any country already do this? It would seem a humane and powerful way to beat other countries / lead the world (pick whatever motivates you).
- DanBC 9y ago
  > The advice was not encouraging. Since I’d already been given the treatment available in my borough, and my weight was only just within the ‘anorexic range’ (below a body mass index of 17), I was told I’d be better off registering with a university GP with access to better mental health services. Anorexia is not about a person's weight, but about their disordered thoughts of food and eating. When someone is doing the right thing and seeking early intervention for those disordered thoughts we should be providing them with a package of care to treat them. We know early intervention is life saving, and is more effective and cheaper than later intervention. By forcing someone to wait until their BMI drops we're saying "come back when you're thinner" -- and that's a lethal thing to say to someone with an eating disorder. Anorexia is one of the most fatal mental illnesses.
amyboyd 9y ago
> "Some of the help and therapy I eventually received was excellent, but as much as my recovery was supported by the NHS, it was also fuelled by my determination never to have to rely on it again." When I read this line, it hit home. I've been in and out of NHS treatment for years for other (not anorexia) issues. I never ever want to rely on the NHS again. They failed me so much I now avoid having to interact with anyone in the medical field. I deliberately avoid going to my GP for anything. Mental health care in the UK is so bad that you really wouldn't believe without first-hand experience. It needs to be scrapped and started again. I don't want to rant here on Hacker News too much (almost never comment) but this hit a nerve and I'm angry just thinking about the mental health care the NHS pretends to provide.
- toomanybeersies 9y ago
  People love comparing countries for their non-mental healthcare (physiological care?), but I never seem to hear about countries that actually have good, functioning mental healthcare systems. New Zealand has what could be described as a well-functioning (most of the time) healthcare system, if you break your arm, it's not a worry at all. But the mental healthcare system is a complete shitshow. It's an absolute disgrace, especially considering that NZ has the highest youth suicide rate in the world.
  - klank 9y ago
    Perhaps it has more to do with us (i.e. humans) not having a deep understanding of mental health treatment? I mean, we really don't understand the mind very well at all. It's not just a clinical understanding either. We culturally approach mental health differently than other health. Get cancer and everybody rushes to your aid. Have anorexia and people ask questions about why we should pay for "self-inflicted" injuries (devil's advocacy couched, but still the question is posed). Thankfully the cultural stance is changing. It wasn't long ago that the question about "self-inflicted" injuries wouldn't have even had to be couched in devil's advocacy.
    - deleted 9y ago
      [deleted]
adwf 9y ago
To play a bit of devil's advocate here: At what point does a socialised health service with limited resources, stop providing care for "self-inflicted" injuries? In a busy hospital, the doctors have to triage and make priority decisions over where to apply resources and who to treat first. Much like an alcoholic would never be at the top of a liver transplant list, at what point would an anorexic - who in this case had already been through over 30 mental health sessions - start to be denied care? At what point is it more ethical to spend those resources treating someone else, who might actually respond to treatment? Again, just playing devil's advocate here. My personal opinion is that the NHS is critically underfunded at the moment and that should be fixed first. But I thought it worth pointing out the ethical debate over treating self-inflicted injuries in a socialised healthcare system is quite tricky. Especially considering that almost all mental health issues can fall under "self-inflicted" if you want to be callous.
- zbentley 9y ago
  I recognize the devil's advocacy and will refrain from judgement on your position. In response, there are a few options (probably more that aren't occurring right now; it has been many years since I was researching this in university): - A "need-blindness" system a la financial aid at US universities, as well as those in a few other countries. This gives deniability as its primary benefit, when people ask "why was the person with a 'self-inflicted' (replace those single quotes with very sarcastic finger wags, please) need above me?" That deniability is imperfect, and causes political problems. - A formalized ranking of factors that influence priority for care, performed by formulae as public and precise as possible. This could potentially include 'self-inflicted' conditions as something exerting downward pressure. Much like sentencing guidelines, there will always be some subjective/human leeway in the application of those formulae that draws accusations, founded or not, of bias. Also, in libertarian political climates, this will draw accusations of governmental meddling in personal decisions. - Pricing care at a level likely to ensure that only a number of patients proportional to available care-giving resources are admitted. This would require massive changes (mostly removals) to subsidies that exist for healthcare. This is unlikely to succeed politically, and from a humanitarian/ethical point of view is likely to be viewed extremely negatively (a view I share). It would have the advantage of making the "real" problem (lack of caregiving resources, including skills and general awareness) directly apparent, but only as a form of shock therapy. Those are ways to address your question directly and narrowly. Secondary solutions/those with knock-on effects (preventative care etc.) are out of scope of this answer. EDIT and as to the "when is it ethical" portion of your question (the above answers are logistical, not ethical), it's a crapshoot. It boils down to the ethical questions of the trolley problem plus the determinism problem, neither of which are generally considered to be tractable alone, much less together.

85 points by fern12 9y ago

It's desperately under-funded: "The hospital itself was old and seemed to be in the process of being shut down around us. Half the wards were empty, including the one opposite – a strange sight to those of us who had nearly died waiting for a bed. In winter, when it was too cold to be taken to ‘the bench’, we would instead be taken down another, deserted corridor, to sit for 15 minutes in a disused waiting room. When the five-bed rehabilitation house for patients leaving the inpatient unit was threatened with closure, doctors started to send patients there at a lower weight than advised, to secure its funding. Funding applications had to be made for each patient every two weeks, and I remember at least one patient being discharged suddenly and prematurely, because she had reached a weight beyond which her Primary Care Trust wouldn’t pay for treatment. Others, including me, had to prove that we weren’t ‘chronic’ cases and therefore worth funding. "

d33 9y ago

> (...) the overstretched staff didn’t have much time to support me, and I was often left crying on my own. Sometimes my tears were taken as evidence of ‘non-compliance’. This, on its own, is already outrageous. What could lead to forming this kind of attitude?

DanBC 9y ago
Eating disorder is often comorbid with what's called "personality disorder" (usually what's called borderline PD). People with that label experience significant levels of stigma and discrimination from health workers, including mental health workers.
- yipopov 9y ago
  That said, it should not be underestimated what an immense strain those people are on mental health workers. I wonder how much time those institutions dedicate to debriefing their own staff, I think that would make a big difference in how the patients are treated as well.
thirdpoliceman 9y ago
Mostly I think its just exhaustion and desensitization. I spent a year in a child unit. Pretty much anything you do can be labeled as non-compliance. Staff got very callous out of necessity. Sometimes there were 20+ restraints in a day and once someone has spent hours restraining screaming/violent/suicidal kids, they don't have any patience or sympathy for someone crying in the corner. And basically anything you do can be labelled as non-compliance. I remember a nurse waking me up in the middle of the night to ask me to look at some paperwork. When I got pissed off (as anyone would) she put in the handover that I was being non-compliant. It's shitty but it seems to be a common attitude. Her experience isn't particularly extreme.

jostmey 9y ago

Quote: "The advice was not encouraging." What would be encouraging to hear?

zelos 9y ago
"There's another 30 hours of counseling and therapy available" (which at ~£50/hr is presumably a lot cheaper than a stay in ICU)
- frabcus 9y ago
  This is what drives me mad. Professional therapy that actually works and can help patients solve the underlying self-esteem issues from childhood isn't easily available to people suffering from anorexia. More generally, I would argue that if we increased tax and gave everyone as much therapy as they need, the money would be saved by reducing sick days for businesses, reducing other healthcare costs, and increasing productivity of mental well people. I think we should do it even if it wouldn't save that money, but intuitively it feels like it would, so it makes not doing it even crazier... Does any country already do this? It would seem a humane and powerful way to beat other countries / lead the world (pick whatever motivates you).
DanBC 9y ago
> The advice was not encouraging. Since I’d already been given the treatment available in my borough, and my weight was only just within the ‘anorexic range’ (below a body mass index of 17), I was told I’d be better off registering with a university GP with access to better mental health services. Anorexia is not about a person's weight, but about their disordered thoughts of food and eating. When someone is doing the right thing and seeking early intervention for those disordered thoughts we should be providing them with a package of care to treat them. We know early intervention is life saving, and is more effective and cheaper than later intervention. By forcing someone to wait until their BMI drops we're saying "come back when you're thinner" -- and that's a lethal thing to say to someone with an eating disorder. Anorexia is one of the most fatal mental illnesses.

amyboyd 9y ago

> "Some of the help and therapy I eventually received was excellent, but as much as my recovery was supported by the NHS, it was also fuelled by my determination never to have to rely on it again." When I read this line, it hit home. I've been in and out of NHS treatment for years for other (not anorexia) issues. I never ever want to rely on the NHS again. They failed me so much I now avoid having to interact with anyone in the medical field. I deliberately avoid going to my GP for anything. Mental health care in the UK is so bad that you really wouldn't believe without first-hand experience. It needs to be scrapped and started again. I don't want to rant here on Hacker News too much (almost never comment) but this hit a nerve and I'm angry just thinking about the mental health care the NHS pretends to provide.

toomanybeersies 9y ago
People love comparing countries for their non-mental healthcare (physiological care?), but I never seem to hear about countries that actually have good, functioning mental healthcare systems. New Zealand has what could be described as a well-functioning (most of the time) healthcare system, if you break your arm, it's not a worry at all. But the mental healthcare system is a complete shitshow. It's an absolute disgrace, especially considering that NZ has the highest youth suicide rate in the world.
- klank 9y ago
  Perhaps it has more to do with us (i.e. humans) not having a deep understanding of mental health treatment? I mean, we really don't understand the mind very well at all. It's not just a clinical understanding either. We culturally approach mental health differently than other health. Get cancer and everybody rushes to your aid. Have anorexia and people ask questions about why we should pay for "self-inflicted" injuries (devil's advocacy couched, but still the question is posed). Thankfully the cultural stance is changing. It wasn't long ago that the question about "self-inflicted" injuries wouldn't have even had to be couched in devil's advocacy.
  - deleted 9y ago
    [deleted]

adwf 9y ago

To play a bit of devil's advocate here: At what point does a socialised health service with limited resources, stop providing care for "self-inflicted" injuries? In a busy hospital, the doctors have to triage and make priority decisions over where to apply resources and who to treat first. Much like an alcoholic would never be at the top of a liver transplant list, at what point would an anorexic - who in this case had already been through over 30 mental health sessions - start to be denied care? At what point is it more ethical to spend those resources treating someone else, who might actually respond to treatment? Again, just playing devil's advocate here. My personal opinion is that the NHS is critically underfunded at the moment and that should be fixed first. But I thought it worth pointing out the ethical debate over treating self-inflicted injuries in a socialised healthcare system is quite tricky. Especially considering that almost all mental health issues can fall under "self-inflicted" if you want to be callous.

zbentley 9y ago
I recognize the devil's advocacy and will refrain from judgement on your position. In response, there are a few options (probably more that aren't occurring right now; it has been many years since I was researching this in university): - A "need-blindness" system a la financial aid at US universities, as well as those in a few other countries. This gives deniability as its primary benefit, when people ask "why was the person with a 'self-inflicted' (replace those single quotes with very sarcastic finger wags, please) need above me?" That deniability is imperfect, and causes political problems. - A formalized ranking of factors that influence priority for care, performed by formulae as public and precise as possible. This could potentially include 'self-inflicted' conditions as something exerting downward pressure. Much like sentencing guidelines, there will always be some subjective/human leeway in the application of those formulae that draws accusations, founded or not, of bias. Also, in libertarian political climates, this will draw accusations of governmental meddling in personal decisions. - Pricing care at a level likely to ensure that only a number of patients proportional to available care-giving resources are admitted. This would require massive changes (mostly removals) to subsidies that exist for healthcare. This is unlikely to succeed politically, and from a humanitarian/ethical point of view is likely to be viewed extremely negatively (a view I share). It would have the advantage of making the "real" problem (lack of caregiving resources, including skills and general awareness) directly apparent, but only as a form of shock therapy. Those are ways to address your question directly and narrowly. Secondary solutions/those with knock-on effects (preventative care etc.) are out of scope of this answer. EDIT and as to the "when is it ethical" portion of your question (the above answers are logistical, not ethical), it's a crapshoot. It boils down to the ethical questions of the trolley problem plus the determinism problem, neither of which are generally considered to be tractable alone, much less together.