Northern Ireland news

Spike in number of teens' eating disorders linked to pandemic

Dr Maggie McGurgan, a consultant child and adolescent psychiatristm says there is "no doubt" the Covid-19 pandemic has impacted on young people, with a sharp increase in the number of hospital admissions among seriously ill teenagers suffering from eating disorders Picture by Mal McCann.
Seanín Graham

CONCERNS are mounting about the long-term impact of the Covid-19 pandemic on children. For young people with mental health illnesses, lockdown has been catastrophic. One leading psychiatrist gives an insight on the changes she has seen in those presenting to services. Health correspondent Seanín Graham reports.

CHILDREN with eating disorders coded as "red" and urgently requiring a hospital bed were "relatively uncommon" in Northern Ireland prior to spring 2020.

However, a surge in the number of paediatric hospital admissions for seriously ill teenagers suffering from conditions such as anorexia is being linked to the pandemic - with a leading child and adolescent psychiatrist warning that levels of illness have changed "markedly" over the last year.

Dr Maggie McGurgan said the severity of conditions meant many young people were admitted "straight away" as they were so underweight and unwell.

Exam year students, in particular 15-year-olds studying for GCSEs, are among those experiencing the "greatest difficulties".

Younger children have also been hospitalised, with two of the north's biggest health trusts confirming that admission rates for the sickest young people with eating disorders have doubled since 2019.

Dr McGurgan, originally from Randalstown in Co Antrim and a member of the Royal College of Psychiatrists, said there was "no doubt" the Covid-19 lockdown had contributed to dramatic changes in presentations to Child and Adolescent Mental Health services (CAMHs) across the north's health trusts.

She said the shift started as early as last May.

"There will be young people who were likely always to have been at risk of this type of difficulty but the change in their life has brought it to the fore," she said.

"Eating disorder patients are masters of secrecy. So now they’re not at school, they’re not seeing their friends, the amount of face-to-face contact is vastly reduced - what they perceive as being in control of is taken away from them. So many coping strategies that are essential to many of us, especially our young people, have been much harder to maintain."

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In an interview with The Irish News, the consultant also expressed concerns about the "missed" patients who were previously picked up through schools and extra-circular activities.

"In the first month or two of last year referrals dropped but went up again very quickly. But actually the level of risk, the level of severity and urgency is very different," Dr McGurgan warned.

"They’re not the same young people we treated prior to the pandemic. So we expect we haven’t seen all that need to be seen.

"Our concern is that many of these children haven't had eyes set on them by a school teacher, by a football coach, by a singing teacher - which was normally was the case.

"You worry about what you’re seeing because it’s different, it's more complex and challenging - but you definitely worry more about what you know you're not seeing."

The medic is based in the Northern trust CAMHs and specialises in the treatment of eating disorders and intellectual disability. She also works with autistic children and those with ADHD.

Both the Northern and Western trusts have confirmed a "significant rise" in more complex referrals among children with eating disorders.

Information provided by the Northern trust revealed that 15 children were admitted to hospital beds between last April and January - with three of that total under the age of 15 - compared with six in the same period the previous year.

Caseloads for clinicians also went up by almost 30 per cent post-lockdown in the Western trust, with a spokeswoman highlighting the lengthy treatment plan for children with anorexia and bulimia - which in some cases can be up to three years.

She also confirmed a "doubling" of young people admitted for "medical stabilisation" to paediatric and general medical hospital beds, with six admissions in 2019 and 11 last year. The Belfast trust's eating disorder clinics saw their referrals rise by more than 30 per cent.

"What we have seen is a very clear preponderance of difficulty among exam-year kids. It's very much a mixed picture - both girls and boys," Dr McGurgan said.

"The children who are at transition stages in life and the young people definitely appear to have the biggest difficulties.

"Those with eating disorders are presenting in a really quite markedly different way than they were over a year ago. Our referrals are not very different in terms of numbers coming in overall, but the level of illness has changed. How sick, how underweight these young people are, is markedly different.

"They very often need to go straight into an inpatient bed, they’re that unwell."

The Northern health trust, which been recognised for its work in treating eating disorders, admits the sickest under-16s to paediatric beds where they are looked after by a psychiatrist and paediatrician - both as inpatients and when they are discharged to outpatient clinics.

"In the past a child coming to us in what is classed the 'red' category would have been relatively uncommon. Now, it’s almost unheard of when a new referral isn’t in the red category. These are patients who are such a low weight for their height that they're at physical risk," Dr McGurgan explained.

"We are currently seeing twice as many contacts as we were a year ago."

With the chief medical officer confirming that some coronavirus restrictions are likely to remain in place for another year, no clarity has been given as to how this will affect schools.

March 8 is earmarked as the earliest date for classrooms reopening - but only for some pupils.

Dr McGurgan said the closure of schools has had an "absolutely massive impact" on children.

"We’ve taken away what was their entire daily structure and weekly routine. We’ve taken this away via the loss of face-to-face teaching in schools but also via the loss of extra-circular activities and sports and hobbies," she said.

"I think it’s hugely challenging for teachers and educators who are certainly stuck between a rock and a hard place in what to do about this. I don’t envy the decision makers. I think when you try to make sense of it, hindsight is much more 20/20 than looking forward, but I suppose had we tried to do more of a blended learning's difficult to know."

As the third wave passes its peak in relation to hospital admissions - though ICU is still under severe pressure - waiting lists for non-Covid illnesses remain one of the biggest challenges for the health service, with experts warning of a mental health 'tsunami'.

"As a society, we’ve had to take decisions to protect our most vulnerable groups and in doing so we have exposed other vulnerabilities in other groups," Dr McGurgan said.

"What lockdown has done is made it so much harder to do the things that help you stay well."

With more investment pledged in children's mental health services over coming months, Dr McGurgan said there was a need to improve not just people's mental health but emotional well being.

"It’s about taking appropriate, decisive steps to minimise risks for the most vulnerable and make it easier for the population, including children, to find ways to look after themselves and to improve their resilience.

"When the small certainties in life are able to come back in some form it helps, as the young people we see thrive on structure."

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