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In the eating disorder unit

lrb.co.uk

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Re: In the eating disorder unit

#21

Post by adwf »

Klathmon wrote: post #15
adwf wrote: post #11

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 h…

I think the analogy is a bit flawed. The whole reason they are there is the mental health issue, so denying them because it's not fixed is more like denying a person with cancer any more treatments because they haven't responded well to the first 30 treatments. A mental health problem is no more "self inflicted" than cancer is. It doesn't really change your ultimate question though.

Yeah, I think that the mental health part confounds the issue. When it's a chronic physical illness, it's a lot easier to give someone pills to take for the rest of their life. Whereas mental health is vaguer and potentially much more expensive.

There are plenty of cancer drugs that the NHS will refuse to prescribe due to their expense. If you want them, you'll be told to go private. If mental health is so expensive, do we say the same thing?

Re: In the eating disorder unit

#22

Post by DanBC »

adwf wrote: post #11

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 h…

Anorexia is a serious mental illness, and there is nothing that's self inflicted about it.

---Edit--- So, I think you're not saying it's self inflicted, but you're wondering if that's the perception that some health staff have, and if that's why they provide poor quality treatment. If so, yes, I agree with you.

People with mental illness often find themselves at A&E. This is usualy because of their physical health - they are appropriately using A&E. (MH medication and illness can have horrible impact on physical health). But also people are often told to go to A&E if they're in crisis and not already under a MH team. That's not a great use of A&E and it's something we try to prevent, by providing better access to "crisis teams".

---end edit---

In the UK a considerable amount of money is spent on inpatient treatment for people with anorexia, and some of that is NHS funding of private for profit provision - for example Priory Group provide a lot of in-patient eating disorder treatment.

The reason it's paid for is because people who are ill deserve treatment, and a death is usually more expensive to the state than the treatment.

The reason so much private for profit provision is funded by NHS is because the NHS has underfunded mental health treatment for many years.

Re: In the eating disorder unit

#23

Post by DanBC »

adwf wrote: post #17
zbentley wrote: post #13

Earlier quoted context omitted.

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 th…

Thank you for the reply, I was a little worried that people would think the question too unpleasant and just downvote to oblivion! I was trying to think of explanations for the apparent callous nature of the emergency doctor who tried to discharge him from A&E and the nurses who gave equally brusk treatment. The first thing that came to mind was that they treated him effectively as a self-inflicted "slow" suicide cas…

Those clinicians did that because they are unlawfully discriminating against someone with mental illness.

And because UK funding for mental illness is so piss-poor there's not much service for those doctors to refer into.

The lack of funding is a political choice, it's got nothing to do with the socialised nature of funding.

Re: In the eating disorder unit

#24

Post by kemiller »

adwf wrote: post #11

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 h…

Should we deny treatment to, say, skydivers or skateboarders? Race drivers?

Re: In the eating disorder unit

#25

Post by QAPereo »

adwf wrote: post #21
Klathmon wrote: post #15

Earlier quoted context omitted.

I think the analogy is a bit flawed. The whole reason they are there is the mental health issue, so denying them because it's not fixed is more like denying a person with cancer any more treatments because they haven't responded well to the first 30 treatments. A mental health problem is no more "self inflicted" than cancer is. It doesn't really change your ultimate question though.

Yeah, I think that the mental health part confounds the issue. When it's a chronic physical illness, it's a lot easier to give someone pills to take for the rest of their life. Whereas mental health is vaguer and potentially much more expensive. There are plenty of cancer drugs that the NHS will refuse to prescribe due to their expense. If you want them, you'll be told to go private. If mental health is so expensive,…

It’s worth looking at patterns of homelessness and mass violence in the US before you take the leap. Mental illness can’t really be ignored, and untreated mental illness is dangerous for the sufferer, and the commmunity.

Re: In the eating disorder unit

#26

Post by cryptonector »

adwf wrote: post #11

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 h…

This is hardly an original thought.

In the UK right now you cannot get surgeries from the NHS if you're a smoker or overweight. They've already made the leap you wonder about.

And there's been talk of the same thing in the U.S. for Medicare.

When you have access to private healthcare, you can decide where you draw the line (based on many many factors, including what resources you have, what resources you want to pass on to your children, etc.). When you don't, you're at the mercy of the state.

Re: In the eating disorder unit

#27

Post by gaius »

adwf wrote: post #11

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 h…

stop providing care for "self-inflicted" injuries?

It’s a question that won’t go away. In the UK the NHS spends £11Bn of its £125Bn annual budget on Type 2 diabetes. Diabetes UK reckon that 80% of cases of this condition are caused by or could be resolved by lifestyle choices. NHS underfunding could be fixed in, not overnight, but in a few months surely if those choices were made... and everyone knows it.

Re: In the eating disorder unit

#28

Post by cryptonector »

Klathmon wrote: post #15
adwf wrote: post #11

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 h…

I think the analogy is a bit flawed. The whole reason they are there is the mental health issue, so denying them because it's not fixed is more like denying a person with cancer any more treatments because they haven't responded well to the first 30 treatments. A mental health problem is no more "self inflicted" than cancer is. It doesn't really change your ultimate question though.

Is smoking an addiction? Is it a mental health issue?

How about overeating (thus obsesity)?

I ask because right now the UK's NHS severely limits access to healthcare for smokers and the obese.

I think the more realistic distinction between anorexia/bulimia on the one hand, and smoking/obesity on the other -if there is a distinction in NHS's "mind"- it's that the former are more sympathetic. But I dunno, I'm just guessing. I have no idea what the mandarins at NHS and similar are thinking, or, rather, will think when their resources become even more constrained than they are now. That is, I suspect they (NHS) make choices about whose healthcare to restrict... entirely on the basis of a) scarcity / need to ration, b) how sympathetic a particular target group is. How else would they (NHS) make such choices anyways? how else could they make them even remotely palatable to the polity?

Re: In the eating disorder unit

#29

Post by pascalxus »

adwf wrote: post #11

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 h…

I agree. There are some types of illness you can't treat yourself: those should be prioritized. This may sound a little callous: but all she had to do was listen to her body and eat more. And, unlike many illnesses, she knew what the problem was and she knew what the solution was.

Re: In the eating disorder unit

#30

Post by thirdpoliceman »

d33 wrote: post #2

> (...) 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?

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.

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