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Trigger warning: This blog contains themes that may be triggering for some people.  Hope Virgo is an author, a multi award winning mental health campaigner, and secretariat for the All-Party Parliamentary Group (APPG) for eating disorders. In this blog, she explores the patient safety issues affecting children with eating disorders and their families. Hope highlights how lack of investment and understanding is leading to avoidable harm and shares five key actions for change.  This blog is part of our World Patient Safety Day 2025 series - Safe care for every newborn and every child. My campaigning work was born out of wanting to fight the injustices that so many people affected by eating disorders go through. Having lived with anorexia from the age of 12-17 before being admitted to a mental health hospital where I began my journey to recovery, I know first-hand just how awful eating disorders are. I have spent huge amounts of life feeling frustrated by how many people get turned away from services for not having that “particular stereotypical look” and with how much neglect is taking place in treatment across the UK. Patient safety concerns Often people still think someone with an eating disorder will be underweight or have been labelled with anorexia. Eating disorders are so much more than that. During my campaign work and the APPG evidence sessions, I’ve met hundreds of people who have been denied treatment for not looking that way. We have spoken to parents who have children with avoidant restrictive food intake disorder (ARFID), who have not been able to access treatment and support. The reality is, there is a postcode lottery and a lot of children and their families aren’t being given the best chance of life. Many carers also tell me how often their concerns are dismissed as silly worries. This cultural dismissiveness across eating disorder services and the lack of training and funding, is leading to huge issues for patient safety. It is causing people to die. It can feel so hard to speak up when support is so limited, but as a parent or carer, learning to push for support is crucial. I’d also recommend looking at the amazing resources for carers produced by the organisation FEAST. Stigma, misunderstanding and dangerous narratives Eating disorders are an illness that is massively stigmatised and misunderstood. Contrary to many assumptions, people with an eating disorder: are not making a lifestyle choice are not being difficult are not all white females. Eating disorders can impact people of any age, size, gender or race. Stigma and misunderstanding leads to so many people being denied treatment for an eating disorder. Marked as ‘untreatable’ One narrative that we have seen in the last two years is an increasing amount of people with eating disorders being marked as untreatable, too complex and in some cases as terminal and moved to palliative care. This dangerous narrative is causing many people to be discharged from services too soon and given inadequate care. If they are discharged prematurely and still have a malnourished brain they are not being given the chance for it to fully rewire - leading them at high risk of relapse. Time for change For too long eating disorders have been stigmatised and underfunded, with very little specific staff training. For children’s services, whilst there has been some investment, it has been very limited. Five key changes to support patient safety The APPG published a report in January 2025 calling on the government for five key things: Develop a national strategy for eating disorders. Provide additional funding for eating disorder services. This funding should address the demand for both adult and children’s services. Launch a confidential inquiry into all eating disorder deaths. Increase research funding for eating disorders: The aim is to enhance treatment outcomes and ultimately discover a cure for eating disorders. Ensure non-executive director oversight for adult and children's eating disorder services. This oversight and accountability should be implemented in all NHS Trusts and Health Boards in the UK. Recovery When you have an eating disorder, it completely consumes you. It takes over every area of your life. And it consumes your family life too. The research shows that people can and do recover at any age, severity of illness or length of illness. So why are we allowing so many to remain stuck living with an eating disorder and denying them the care they need? Over the last few years. we have seen pockets of good practice in services from the development of integrated enhanced cognitive behavioural (I-CBTE) therapy, to areas where GPs have quickly referred patients or supported families to recover. With the right support and treatment in place for people with eating disorders we will not only save lives but also money. Through early intervention we can prevent hospital admissions and prevent begin becoming more malnourished thus leading to quicker recovery times. Final thoughts Eating disorders are a serious mental health issue. They have the highest mortality rate of any other psychiatric illness yet are often hidden in plain sight. It doesn’t have to be this way. People with eating disorders can and do make full recoveries, we just need to do better to enable this to happen. This growing epidemic can only be reversed by investing into prevention, early intervention, and timely, high-quality treatment. Access to services needs to be free from discriminating criteria and bias. The current inpatient treatment approach results in poor outcomes and 40-50 percent relapse rates. Without a cultural shift and a complete reformation of services nothing is going to change. Campaigners, clinicians and others need to work together to make this change happen. March with us On 21 June, 2025, we’ll be taking to the streets of London for the third consecutive year to march for those we love, for those we have lost, and for the future generations affected by eating disorders. This march is not just a walk — it’s a statement to demand better services and put an end to the neglect faced by those struggling with eating disorders across the UK. Find out how you can join.

Mental Health Awareness Week is an annual event which aims to raise awareness and promote open conversations about mental health.  In this Top picks, we’ve pulled together resources, blogs and reports from the hub that focus on improving patient safety across different aspects of mental health services and also supporting staff with their own mental health and wellbeing. 1 Restraint Reduction Network: Supporting people with lived experience As all forms of restrictive practice can result in harm, it is important that people are able to identify restrictive practices and challenge their inappropriate use. The Restraint Reduction Network have a range of resources that people with lived experience, parents and carers may find helpful. The resources are designed to support people to understand what restrictive practices are, when and why they might be used, people’s rights, and how to identify and challenge unacceptable and unethical practices. 2 Harry’s story: Acute Behavioural Disturbance In December 2022, Harry Vass died after experiencing Acute Behavioural Disturbance (ABD) and a complex disturbance in normal physiology. Harry’s death was found to be avoidable as carers were not fully aware of this condition associated with acute psychosis. In this blog, Harry’s mother Julie describes the barriers they faced in getting the right support and care for Harry before he died and highlights the need for healthcare staff to have a greater awareness of ABD and the associated risks of a medical emergency. You can also read a second blog by Julie, where she explains more about Acute Behavioural Disturbance and the changes she believes are needed to make sure patients like Harry are cared for appropriately. 3 Life Beyond the Cubicle: eLearning to support working well with families during mental health crises A set of eLearning modules designed to educate and update clinicians on the importance of involving families wherever possible during mental health crises to improve patient care, avoid harm and reduce deaths. They were developed as a partnership between Oxford Health NHS Foundation Trust and Making Families Count, with funding from NHS England South East Region (HEE legacy funds). The resources have been co-produced by people with lived experience as patients, family carers and clinicians, supported by an Advisory Group drawn from a wide range of expertise, tested in eleven NHS Trusts and independently evaluated. 4 Mental health crises: how to improve care In May 2024, National Institute for Health and Care Research (NIHR) Evidence held a webinar on care for adults in mental health crisis. The webinar shared research findings on what works in community crisis care, how acute day units compare to crisis resolution teams and whether peer-supported self-management can reduce acute readmissions. This Collection summarises the 3 research projects presented at the webinar. It includes video clips from the speakers and incorporates quotes from the day. The information will be useful for anyone involved in commissioning or delivering mental health crisis services. 5 Self-harm: assessment, management and preventing recurrence This new guideline from the National Institute for Health and Care Excellence (NICE) covers assessment, management and preventing recurrence for children, young people and adults who have self-harmed. It includes those with a mental health problem, neurodevelopmental disorder or learning disability and applies to all sectors that work with people who have self-harmed. The guideline sets out some important principles for care and treatment. For example, it states that self-harming patients treated in primary care must receive regular follow-up appointments, regular reviews of self-harm behaviour and a regular medicines review. 6 Hope Virgo: What needs to happen to stop people with eating disorders being failed by the healthcare system? In this blog, Hope Virgo, author and Secretariat for the All Party Parliamentary Group (APPG) on Eating Disorders, examines the crisis that continues in eating disorder services in the UK and the devastating impact this is having on patients and their families. She highlights how failures in services lead to avoidable deaths. Hope shares the key recommendations from a new report by the APPG and calls for adequate funding and attention to ensure people with eating disorders receive the help they need to recover. 7 Rethinking doctors’ mental health and the impact on patient safety: A blog by Ehi Iden This blog by Ehi Iden, hub topic lead for Occupational Health and Safety, reflects on the increasing workload and pressure healthcare professionals face, the impact this has on patient safety and why we need to start 're-humanising' the workplace. He highlights that, “It takes a safe healthcare worker to deliver safe healthcare to patients.” 8 Zero Suicide Alliance training The Zero Suicide Alliance is a collaboration of NHS trusts, charities, businesses and individuals who are committed to suicide prevention in the UK and beyond. Their website offers free online training courses to teach people the skills and confidence to have potentially life-saving conversations with someone they’re worried about. They offer short online modules covering general suicide awareness, social isolation and suicide in veterans and university students. 9 How can our team move past a traumatic event? After an extreme traumatic event there are things that you can do to help yourself, and your colleagues, to move on. Fiona Day, medical and public health leadership coach and chartered coaching psychologist, Stacey Killick, consultant paediatrician at Glan Clwyd Hospital, and Lucy Easthope, professor in practice at Durham University’s Institute of Hazard, Risk, and Resilience and adviser on disaster recovery give their tips in this BMJ article. 10 Blog: Shifting the dial on mental health support for young black men In this blog for NHS Confederation, Kadra Abdinasir talks about how mental health services have failed to engage with young black men, and describes how services need to change to overcome the issue. She argues that delivering effective mental health support for young black men requires a move away from a crisis-driven response, to investment in system-driven, community-based projects. Kadra looks at learning from Shifting the Dial, a three-year programme recently piloted in Birmingham as a response to the growing and unmet needs of young black men aged 16 to 25. A recent report on the project found that most young men involved in Shifting the Dial reported good outcomes related to their wellbeing, confidence, sense of belonging and understanding of mental health. 11 Vicarious trauma: The invisible epidemic In healthcare, an insidious epidemic lurks beneath the surface, affecting the very individuals tasked with providing care: vicarious trauma by empathy. Despite its profound impact, this phenomenon remains largely unrecognised and under-discussed within the sector. As leaders, it is imperative that we shed light on this invisible trauma and acknowledge it as one of the greatest challenges facing our industry, as Margarida Pacheco explains in this blog. 12 Beyond stereotypes: A lived experience guide to navigating support for disordered eating Disordered eating can affect anyone, but it can be confusing to understand and recognise it in our own personal experiences. This guide, published by East London NHS Foundation Trust, is a snapshot of how adults in East London have navigated those experiences of uncertainty while seeking support for disordered eating. For many of the contributors, preconceptions about what an eating disorder is (or isn’t) have previously acted as a barrier to seeking or receiving support. It also contains advice on how to seek support for disordered eating. 13 “The alarming rate of suicide among healthcare workers should be a wake-up call in the urgent need to support them” Frontline19 was established at the start of the Covid pandemic as an urgent response to support frontline workers who were under extreme pressure and experiencing significant mental health challenges. Psychotherapist Claire Goodwin-Fee is the founder and CEO of Frontline19. In this blog, Claire explains how systemic pressures and stigma around mental health are continuing to leave healthcare staff extremely vulnerable. 14 Blog: Why harmful gender stereotypes surrounding men’s approaches towards their feelings need challenging This blog explores why men are reluctant to seek support when they are struggling with their mental health and why the suicide rate is so high. It looks at initiatives that exist to encourage men to seek help and highlights what more could be done to support mens’ mental health. 15 Learning how to protect the health system by protecting the caregivers This commentary in JAMA Network Open looks at the increasingly recognised problem of burnout among US healthcare professionals. General Social Survey data suggest that almost one-half of US health care workers experienced symptoms of burnout often or very often in 2022, up from less than one-third in 2018. The article explores research that demonstrates the extent of the issue and highlights studies looking at ways to reduce burnout. The authors conclude that systemic change will be required to tackle the issue. 16 Time for a rebalance: psychological and emotional well-being in the healthcare workforce as the foundation for patient safety In this editorial for BMJ Quality and Safety, Kate Kirk explains why staff well-being is the foundation to improving patient safety. 17 Top tips and key actions for successful collaborative partnership working across mental health services These top tips and key actions have been co-developed to support effective collaborative partnership working in the planning and delivery of community mental health services. They recognise that every heath and care system will experience challenges in relation to partnership working given the statutory and cultural differences of organisations working across the mental health pathways and that there will be different arrangements to frame local partnership working, including for example a Section 75 agreement. 18 Balancing care: The psychological impact of ensuring patient safety In this blog, Leah Bowden, a patient safety specialist, reflects on the impact her job has on her mental health and family life. She discusses why there needs to be specialised clinical supervision for staff involved in reviewing patient safety incidents and how organisations need to come together to identify ways we can support our patient safety teams. Have your say Do you have any stories, insights or resources related to mental health? We would love to hear from you! Comment below (register for free here first) Get in touch with us directly to share your insights.

In this blog, Hope Virgo, author and Secretariat for the All Party Parliamentary Group (APPG) on Eating Disorders, examines the crisis that continues in eating disorder services in the UK and the devastating impact this is having on patients and their families. She highlights how failures in services lead to avoidable deaths. Hope shares the key recommendations from a new report by the APPG and calls for adequate funding and attention to ensure people with eating disorders receive the help they need to recover. Eating disorders are among the most serious and life-threatening mental illnesses but have been overlooked and underfunded for far too long. Because of this, eating disorders have one of the largest treatment gaps in modern healthcare. In the past decade, we have seen an alarming rise in eating disorders, a trend that only worsened during the Covid-19 pandemic.[1] What was already a struggling support system for people affected by eating disorders has collapsed under this pressure. Too many people are waiting for support from treatment services that have been grossly underfunded and neglected for many years. In addition, public perception of eating disorders is still dominated by narrow stereotypes—but eating disorders don't discriminate and affect people of all ages, genders and ethnic backgrounds. Understanding the situation for people with eating disorders in the UK Over the last six months, the All-Party Parliamentary Group (APPG) on Eating Disorders has been meeting with people affected by eating disorders, clinicians, researchers and campaigners to gain an accurate picture of what is going on in the UK. The stories we have heard are harrowing and eye-opening to the epidemic of eating disorders that our healthcare system faces. We have heard stories of people: being denied treatment for not being thin enough. spending nights in A&E being hydrated, only to be discharged out into the community with no follow-up plan or treatment package. people being discharged from inpatient and outpatient treatment at low BMIs. In some cases, this has resulted in organ failure, suicide or repeat admissions to A&E where people have been crying out for support, only to be blamed for their condition. avoidable deaths. These stories have added to the evidence seen in the pre-pandemic survey of adult community eating disorder services, which highlighted significant shortcomings in community services’ capacity to manage risk. Only around 40% of services provided complete medical monitoring and/or had good links with acute hospitals.[2] Unfortunately, as the severity of a patient's illness increases, the likelihood of them seeking and accepting help decreases significantly. This means that the inability of 50% of services to provide follow ups or assertive outreach to patients who do not engage further increases the risk of deterioration these patients in the community. The statistics we have from the Office for National Statistics (ONS) show much lower mortality figures than we believe to be the case, which is likely due to inaccuracies in recording practices. For those with anorexia, deaths are often caused by physical complications such as malnutrition, gastrointestinal issues, metabolic disturbances, cardiovascular events or infections, and recorded as such. Type 1 diabetes with disordered eating (T1DE) significantly increases the risk of premature mortality. These risks can be reduced with improved services and targeted medical training. Several psychiatric conditions can occur alongside eating disorders, including substance misuse, personality disorders and self-harm. This further heightens the risk of a person dying, which is why we need integrated care to bridge gaps between eating disorder and other mental health services. International studies have shown that integrated, timely services can improve outcomes and prevent deaths.[3] Zara had an eating disorder and tragically died from suicide. Zara’s mum, Debs, believes her daughter would still be alive if she had received the support she needed and asked for. “My beautiful daughter, Zara—intelligent, sassy, kind, and compassionate—took her own life on 22 September 2021 after struggling with an eating disorder for nearly 10 years. Zara was diagnosed with Anorexia Nervosa in May 2013 and was admitted to an Eating Disorder Unit almost immediately. Instead of being good news for her recovery, this is when the nightmare began. From May 2013 to June 2021, Zara endured 13 inpatient admissions across seven different units, including three years as a continuous inpatient—nearly two of which she spent without ever leaving one of the units or going outside. With each admission, her eating disorder and mental health deteriorated further. During this time, she was restrained daily, often by a minimum of six people holding her down. She received very little therapy, and instead, there was a culture of patient blaming and shaming. In the last two years of her life, Zara was crying out for help, but no one would listen. The Eating Disorder Unit discharged her completely, handing her over to the community mental health team. I spent nearly every day taking ligatures off her, lifting her down from her wardrobe when I found her near unconscious, and performing CPR when I found her in the shower. There was little to no support from our community psychiatrist; we were left to cope alone. No matter how much we pleaded for help, it was a constant battle, and we never received the support Zara so desperately needed. My beautiful daughter should never have died from this illness. There was a whole world out there for her, and she had so much to give. But ultimately, Zara felt like everyone had given up on her. She was only 24 when she died, but she was exhausted, and didn’t know any other way to keep going without support." Zara's story is one of many similar stories that are unfolding for countless others across the country. Behind these tragedies are systemic failures, often overlooked and hidden behind a lack of national data, questionable legal decision-making and cost-saving agendas. New APPG report—The Right to health: people with eating disorders failed The APPG on eating disorders has released its first report into the state of eating disorder services in the UK. It makes five recommendations for the Government, including the call for a confidential inquiry into all eating disorder deaths. Development of a national strategy for eating disorders. This strategy will encompass adults and young people, with sufficient funding to reform all services. The goal is to provide timely, evidence-based treatment for every individual with an eating disorder. The national strategy will include: - mandatory eating disorder training for all healthcare workers (including GPs, dentists and nurses). - investment in a public health campaign to clarify messaging around obesity and eating disorders. - funding for the implementation and integration of evidence-based treatment practices, including collaboration between services. - mandatory health screening for high-risk groups. - training for carers. Additional funding for eating disorder services. This funding should address the demand for both adult and children's services. Confidential inquiry into all eating disorder deaths. Increased research funding for eating disorders. The aim is to enhance treatment outcomes and ultimately discover a cure for eating disorders. Non-executive director oversight for eating disorder services. This oversight and accountability should be implemented in all NHS Trusts and Health Boards in the UK. James Downs, a Researcher and Campaigner who shared his own lived experience as part of the APPG evidence sessions, told us that, “Patient safety must be at the heart of reform. Transparency and accountability about the failures in eating disorder services are long overdue, and every NHS Trust and Health Board must include non-executive directors focused on eating disorder services to provide ongoing scrutiny and progress.” With integrated, well-resourced, and evidence-based treatment, recovery is possible, even in the most severe cases and after many years of suffering. Despite this, coroners, families and communities continue to see too many lives needlessly lost. This should not be happening. Eating disorders are treatable illnesses. They are dangerous and life-threatening when untreated, undertreated or poorly treated. But this risk to life is preventable, and deaths from eating disorders are not inevitable. Suzanne Baker, Carer Representative at F.E.A.S.T., gave evidence for the APPG and said, “It is a national scandal that this basic treatment expectation is not being met, leading to preventable deaths. Recovery should be the goal for every patient—a goal that is entirely achievable with the right treatment.” A confidential inquiry is urgently needed to identify modifiable factors that contribute to preventable deaths. We need to see targeted interventions, service improvements and enhanced professional training to address gaps in care delivery. Our question for the Government and the NHS is this: Why in the face of crisis is so little being done to support those affected by eating disorders? Join the conversation Do you have an eating disorder or care for someone who does? We'd like to hear about your experience of accessing services and support. Are you a healthcare professional working in eating disorder services? Share your reflections about how care and treatment can be improved and made accessible to all. You can join the conversation by commenting below (you'll need to sign up to join the hub first) or get in touch with us directly by emailing [email protected] References 1 NHS Benchmarking Network. Accessed 12 January 2025 2 Viljoen D, King E, Harris S et al., 'The alarms should no longer be ignored: Survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19'. BJPsych Bull. 2023; 48(4):1-9 3 Castellini G, Caini S, Cassioli E et al, 'Mortality and care of eating disorders'. Acta Psychiatr Scand. 2023; 147(2): 122-133 Related reading In conversation with Hope Virgo: “The withdrawal of treatment from people with eating disorders is a national crisis that’s being ignored.” Your illness worsens – so care is cut off. This is the scandal playing out in eating disorder treatment (Guardian, 25 February 2024) The right to health: People with eating disorders are being failed (22 January 2025)

This Eating Disorders Awareness Week, Beat is asking for all future doctors to be given the training they need on eating disorders, and we need your help. We are holding a webinar to discuss this campaign and your role in taking it to the next level. During the webinar, the campaigns team will be covering: The history of medical training on eating disorders in the UK What changes Beat are campaigning for The progress of the campaign so far How you can get involved in the campaign Register

Bringing together clinical expertise, lived experience and new research, EDIC 2022 will showcase and debate approaches for re-establishing our eating disorder services in the most equitable, accessible and impactful way possible as we rebuild after the pandemic. Register