Why Scots with eating disorders are seeking treatment abroad, amid 'huge' NHS Scotland waiting lists

A young Scottish woman has described her journey to the far east to receive life-saving treatment for her eating disorder – as Scots back home face lengthy waiting lists and a lack of resources.

Lauren Hastings, 26, was given just a year to live after exhausting all treatment options in Scotland for her eating disorder, which started aged just 13.

The young Edinburgh-native said she has had an addiction to the gym and under-eating from a young age, which slowly developed into purging meals.

Lauren Hastings, 26, was given just a year to live after exhausting all treatment options in Scotland for her eating disorder

“I don’t know why I was sick the first time, but from that day I would throw up multiple times every single day for years,” she said, adding that she would even skip work to go to the gym.

Ms Hastings turned to a Thailand-based addiction and mental health rehabilitation centre, called The Dawn, which claims its prices are roughly half of what UK-based rehab centres charge.

“I can start to love myself again,” Ms Hastings said. “I can be honest, I can speak to people, I can be free. And the most important one of all, I can see myself having a future.

“In Scotland, the emphasis was often on my weight gain, with assurances that I was 'fine' after I gained weight. Yet, I knew that I wasn’t.”

Lauren Hastings, in the midst of her eating disorder

The availability of foreign therapeutic retreats comes against the backdrop of NHS Scotland experiencing worsening waiting lists and a staff recruitment and retention crisis.

Earlier this year, The Scotsman revealed how hundreds of Scottish adults and dozens of children had been left waiting for eating disorder treatment on the NHS.

Freedom of Information requests to Scotland’s 14 health boards revealed at least 25 children were waiting for treatment for an eating disorder, with the majority in the NHS Greater Glasgow and Clyde area.

Ten under-18s were awaiting treatment in Glasgow, while seven were waiting in NHS Highland’s area. Five were waiting in Ayrshire and Arran, while two needed treatment in Tayside.

In the Scottish Borders, the NHS health board responded there were ‘less than five’ children awaiting treatment, while the remaining health boards said they had no children on eating disorder waiting lists.

The numbers are worse for adults, with nearly 400 people sitting on waiting lists. In NHS Lothian, 203 people were awaiting treatment in February, the largest number by far, with NHS Forth Valley a distant second with 53 people awaiting treatment.

The Dawn said its most common age group of British patients was those between 35 and 44 years old, who make up a quarter of their admission. The top three addictions British patients are treated for are alcohol (39 per cent of admissions), cocaine (13 per cent) and cannabis (4 per cent).

The top three mental health conditions British patients are treated for are depression (43 per cent of admission), anxiety (39 per cent) and trauma/PTSD (28 per cent).

Diane Waugh, operation director at the Edinburgh-based national eating disorder charity SupportED, said there were barriers to accessing treatment in Scotland.

“Often, we’re the first people who are called when someone thinks they might have an eating disorder,” she said. “The first person we tell people to contact is their GP, as they hold the keys to the mental health treatment available.

“That’s the first barrier, as not all GPs are knowledgeable about eating disorders. They might diagnose them with anxiety, or something else, as they may not present as someone who is typically anorexic, for example.”

The second barrier to accessing treatment, Ms Waugh said, “is put up by people themselves, because often the stigma of mental health issues”.

“It’s something they’ve been fighting for on average two years before they seek help,” she said. “At their GP, they are then told they are depressed or anxious, and GPs might look at medication. People find themselves misunderstood and so try to treat it themselves.

“We send people back to their GP, hoping to find one that is knowledgeable, so it’s a little bit of a lottery. We’ve tried to raise awareness of this issue.”

GPs that are knowledgeable of eating disorders will refer people to their community mental health team, Ms Waugh said.

“They can provide therapy, and help them tackle their food behaviours,” she said. “If that fails, that’s when the referral to specialist eating disorder treatment centres happens.”

However, patients are facing a 12 to 18-week waiting list amidst “a huge rise” in people presenting with an eating disorder following the pandemic, Ms Waugh said.

“That’s quite a long time for someone with an ED [eating disorder] to wait,” she said. “People become desperate when they’re waiting on some sort of treatment. The ED clinics do the best they can.

“If you’re not in a life-threatening condition, you’re waiting longer because there’s only so much staff and resources available. There was a huge rise, following the pandemic, of people identifying with eating disorders.

“Eating disorders thrive in isolation. People were furloughed, at home, where people had these behaviours in secret.”

When asked about foreign rehab clinics, Ms Waugh said: “There’s a slight concern here, that we have people advocating for these places, where you can go and recover, but these are outwith the financial reach of the vast majority of people. It’s not going to be possible for most people. It’s like dangling a carrot you can never get.

“There are private facilities in England, and The Priory in Scotland, so there are private, fee-paying clinics in this country. In general, recovery rates are pretty poor. That’s more to do with the illness itself, rather than the efforts of the NHS, which has some fantastic, very experienced consultants.

“Recovery takes an average of seven years and for most people it’s not a full recovery.”

Helen Wells, the clinical director at The Dawn Wellness Centre and Rehab, said: “The NHS mental health services are mostly offered through outpatient channels that include primary care, community mental health teams, group counselling and referral to private operators subsidised by the government.

“However, wait times to access primary care, I believe, can be rather long due to high demand and limited resources. Many of our British clients have had to wait between one to three months for an initial consultation, and some over six months for a referral to a specialist.

“According to our clients, it also seems that the NHS stresses a more pharmacological treatment approach versus a psychotherapeutic one, which would require more time and patient focus.”