Fresh concerns have been raised that young people in need of mental health support are falling through the cracks, as latest data shows ‘staggering rise’ in eating disorders among teenage girls.
Dennis Singson, an advanced mental health nurse practitioner working in a general practice in Eastbourne, told Nursing in Practice that many teenagers and young people are stuck in an ‘amber zone’ – where their needs are too critical for general practice but not severe enough for specialist services.
His comments come after a new study shined a light on the rise in both eating disorders and self-harm among teenage girls since the pandemic, as per data from general practices.
Researchers from The University of Manchester, Keele University, University of Exeter, and mental health research charity The McPin Foundation, analysed the records of over nine million patients in UK general practices between January 1 2010 and March 31 2022.
While incidence of eating disorders and self-harm were lower or the same as expected among men and older women, the study found significant increases among teenage girls since the pandemic particularly among those aged 13-16.
Researchers found that the incidence of eating disorders and self-harm among teenage girls was around 40% higher since March 2020, than would have been expected based on pre-pandemic trends.
Lead author for the report, Dr Pearl Mock from the University of Manchester, said that the reasons for this increase ‘could be due to a mixture of issues such as social isolation, anxiety resulting from changing routines, disruption in education, unhealthy social media influences, and increased clinical awareness’.
Incidence of eating disorders among girls aged 13-16 was 42% higher than expected, compared with 32% higher for those aged 17-19. Likewise, the incidence of self-harm among girls aged 13-16 was 38% greater than expected.
Dr Shruti Garg, child and adolescent psychiatrist and co-investigator from The University of Manchester, said that these ‘staggering’ increases highlighted the ‘urgent need to improve early access to services and for timely intervention’.
Meanwhile, Dennis Singson, an advanced mental health nurse practitioner working in a general practice in Eastbourne, told Nursing in Practice that even before this sharp increase there was ‘never enough resources’ for children and adolescents.
A significant issue with mental health nursing in general practice, Mr Singson explained, is that many young patients fall into the cracks between primary and secondary care.
He said: ‘These are the people who fall into the cracks, because GPs might not necessarily have the expertise in dealing with people with mental health difficulties and the risk they present, so they end up just being passed onto specialist services.
‘But specialist services will say “your case isn’t severe enough for us, you’re not as risky as compared to the other people that we deal with, so go back to the GP”.’
From August 2022, Mr Singson has been running a mental health hub from a general practice. Since its inception, the hub has taken on two social prescribers, an additional mental health nurse, and a part-time mental health pharmacist to meet demand.
Unlike many other mental health nurses, Mr Singson is employed directly by his general practice, rather than working for the local NHS trust and being deployed into the community.
Mr Singson said a ‘mission’ being worked on was to ‘bridge the gap between primary and secondary mental health services so less people fall within the crack’.
He added that it was ‘sad to think’ that in five years’ time many children he sees in primary care would ‘be the same people who will end up having eating disorders and self-harming because they can’t cope with the things they are experiencing now’.
‘Nurses are struggling with how to deal with children who can’t cope with being in school; what will happen to them? That’s precisely why I’m here [in general practice] preventing rather than treating these issues for ever and ever.’
Sharon White, chief executive of the School and Public Health Nursing Association (SAPHNA), that an ongoing trend of rising mental health issues among children and young people had been exacerbated both by the pandemic and the cost-of-living crisis.
Ms White added that ‘cuts to vital services such as school nursing youth work’ has meant that children have not had access to preventative care, leading to more escalation to specialist services.
A public health approach to mental health on the other hand, Ms White explained, would mean that ‘through health promotion and empowering health literacy, visible and confidence, school nursing services can prevent eating disorders and mental health issues in the first place’.
The researchers also found that the increase in self-harm and eating disorder incidence was affected by the socio-economic status of the patient.
In the 10 years leading up to the pandemic, rates of eating disorders were higher in the least deprived areas than in the most deprived, suggested the study.
After March 2020, this gap widened further with incidence increasing 52% in the least deprived areas compared with only 22% in the most deprived.
The report’s authors suggested that this might reflect ‘increased willingness among individuals from more affluent areas to seek clinical treatment, and better access to health-care services in these neighbourhoods’.
On the other hand, pre-pandemic rates of self-harm were higher in the most deprived areas than in the least, but after March 2020 this gap narrowed.
A Department of Health and Social Care spokesperson said: ‘We recognise the devastating impact eating disorders can have on an individual and family’s life, which is why we’re investing an additional £2.3 billion a year in NHS mental health services by March 2024, so more adults, children and young people in England can receive appropriate treatment.
‘Capacity at children and young people’s community eating disorder services is also being increased across the country thanks to an additional government investment of up to £54 million a year by March 2024.’