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In the eating disorder unit

lrb.co.uk

31–40 of 40 posts

Re: In the eating disorder unit

#31
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?

No I don't think we should deny treatment to anyone; I wasn't advocating for that.

The question is more, is there a theoretical end to care when the patient has failed to respond to treatment? Is there a point at which we prioritise those resources for someone else who is also in need?

Re: In the eating disorder unit

#32
post #19

Earlier quoted context omitted.

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 disgra…

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" injuri…

[deleted]

Re: In the eating disorder unit

#33
post #22
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 -…

Yes, it's the perception that is concerning me a lot. To the physical doctor in A&E the prescription for anorexia is "1 cheeseburger daily" to which the patient says "no". To the doctor, this is then self-inflicted and less deserving of sympathy.

I agree completely that the NHS is critically underfunded and preventative mental health treatment is the ideal course of action. I didn't mean to imply that completely refusing to treat is an option, more wondering if there's a point at which a doctor can turn around and say "You say no, therefore I say no".

Re: In the eating disorder unit

#34
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…

>In the UK right now you cannot get surgeries from the NHS if you're a smoker or overweight

This seems like such a broad statement that it can't be accurate. I'm assuming you're referring to some non-emergent and elective procedures, right?

Re: In the eating disorder unit

#35
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.

Spoken like someone who doesn't have a mental illness.

Anorexics can fix themselves! All they need to do is eat!

Depressed people can fix themselves! They just need to be happy!

ADD sufferers can fix themselves! They just need to focus!

Do you honestly think these things would be called mental DISORDERS if the solutions were this easy!?

Re: In the eating disorder unit

#36

Earlier quoted context omitted.

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…

>In the UK right now you cannot get surgeries from the NHS if you're a smoker or overweight This seems like such a broad statement that it can't be accurate. I'm assuming you're referring to some non-emergent and elective procedures, right?

http://www.telegraph.co.uk/news/2017/10/17/nhs-provokes-fury....

> But the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional.

And what is "non-urgent surgery"? Who knows. If you need knee surgery, it's probably not urgent, but you may not be able to work without it, thus having very high social costs (unemployment, disability benefits, lost labor, ...) as well as very high personal costs. But NHS almost certainly doesn't have the resources even to consider the negative externalities of this policy -- they are acting out of desperation.

Re: In the eating disorder unit

#37
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.

We seem to be making distinctions based on some concept of free will. What happens if we view ill people as having no free will? Is it really any more wrong to deny the alcoholic high priority on the liver transplant list than to deny someone who isn't taking well to established treatments and keeps relapsing further access to treatments?

I feel like bringing up the notion of choice and free will is opening a can of black holes, but when dealing with mental illness you have to.

Re: In the eating disorder unit

#38
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…

> My personal opinion is that the NHS is critically underfunded at the moment and that should be fixed first.

Sounds wrong to me, but I know nothing about mental health in the UK. It's really hard to fix corrupted institutions without just restarting them from scratch. Throwing money at such institutions (in my opinion) tends to do more harm than good.

Re: In the eating disorder unit

#39
post #19

Earlier quoted context omitted.

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 disgra…

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" injuri…

I'm a clinical psychologist in the US, and it is a complete total shitshow, a combination of stigma and bigotry from outside the system, and self-inflicted nonsense from within.

People misunderstand and have trouble thinking of mental health to begin with, so you end up with general attitudes of "people just have to pull themselves up by their bootstraps" or "just get over it," not understanding that the problem is often that people lack that ability. Other times it's just sheer lack of empathy for people who have had to deal with more difficult circumstances (or even just different circumstances). And then there's the recurring idea that behavioral sciences should just be like all the other sciences, or that it's not worth paying attention to because we don't have it all figured out like basic Newtonian physics.

On the other side, within the field it's a mess too. There should be many more professional models, for example, and a lot more to offer, but territorial battles screw it over for everyone. Psychologists, for example, shoot themselves in the foot with bullshit licensing requirements for reasons I don't understand (maybe to appear more rigorous? to keep competition from entering the field?), requirements that are even more stringent than for MDs in certain ways. There's also no reason psychologists shouldn't be able to learn to prescribe--many people enter clinical doctoral programs with as much natural sciences as premeds, and leave having all sorts of neuro-genetic-chemical-physiology coursework and research experience, often more than MDs in the area of neurobehavioral sciences per se. But psychiatrists bristle at the competition, and certain segments of psychologists want to control the field with their romanticized idea of what psychology "should be," again, for reasons I don't understand.

On top of that, there's various trends in treatment that have led to screwing clients over, to put it bluntly. I can't tell you the number of times I hear colleagues (not all, but a sold number) argue that treatment should be limited for its own sake, to prevent dependency or to encourage change. Sometimes that's true, but you wouldn't say that a cancer patient in need of treatment should have their treatment stopped just to teach them a lesson. And drugs are great for some people, but not for others, and in general, the administration of those drugs has become divorced from any kind of real monitoring of peoples' situations. Add to that the fact that many people's problems derive from the collapse of societal safety nets, which also means lack of funding for mental health services, and, well, you get the point.

Re: In the eating disorder unit

#40
post #14
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…

Indeed, that's a dangerous path to start down. Something like 60% of the UK population is overweight: do we stop treating Type 2 diabetes because it's self-inflicted? It would save billions of pounds, after all. Personally I think people should take some personal responsibility for the NHS's under funding. We eat too much, drink too much, don't do enough exercise and drive dangerously - it's hardly surprising the hea…

The biggest risk factor for most illness is getting old, you can't avoid that with a change in lifestyle.
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