NHS Units Discharge Eating Disorder Patients with Dangerously Low BMIs
Mental health units across England are discharging patients with eating disorders while they still have "dangerously low" body mass index levels, according to recent revelations. Some individuals are being sent home with BMIs below 15, a threshold classified as severe malnutrition by the World Health Organization, and far short of the NHS's usual minimum target of 18.5 to 19 for safe discharge.
Alarming Discharge Practices Revealed
Freedom of information requests submitted by eating disorders campaigner Hope Virgo to NHS mental health trusts in England have uncovered that nine trusts discharged a total of 119 patients with conditions such as anorexia nervosa and avoidant restrictive food intake disorder between January and November last year, despite BMIs less than 15. These figures are likely an underestimate, as only nine of the 54 specialist mental health trusts provided data.
Dr Agnes Ayton, an NHS consultant psychiatrist and vice-chair of the eating disorders faculty of the Royal College of Psychiatrists, emphasized that a BMI of 15 indicates severe malnutrition. "Discharge at this level may occur, but it means that the person remains seriously unwell and requires ongoing monitoring by the GP," she stated. "Mortality in anorexia nervosa increases very substantially at very low BMI due to both physical complications or suicide. Discharge at this stage carries a high risk of rapid relapse, progression to a chronic course or further physical and psychological deterioration."
Expert Concerns and Clinical Guidelines
Experts have described the findings as "horrifying," linking them to NHS services struggling to cope with surging demand. Dr Ashish Kumar, chair of the eating disorders faculty of the Royal College of Psychiatrists, noted that discharge decisions are based on multiple risk factors, not just BMI, but acknowledged that a BMI of 19 is generally considered healthy for discharge.
However, Bethany Francois, a dietitian specializing in eating disorders, expressed strong concerns: "In my experience, no individual I've ever worked with has been well enough to be discharged from eating disorder treatment at a BMI of 15." She highlighted risks such as cardiovascular instability, hormonal disruption, compromised immune function, and bone density loss at such low weights.
Specific Trust Discharges and Responses
Notable cases include the South London and the Maudsley trust, which discharged nine people with BMIs less than 15, including one as low as 12.5. Central and North West London trust discharged 38 patients, Gloucestershire Health and Care trust 22, and Cumbria, Northumberland, Tyne and Wear trust 14.
Hope Virgo criticized these practices, stating: "These figures expose a deeply troubling pattern. Discharging people at BMIs associated with extreme severity and high mortality risk is not a neutral clinical decision, it is a failure of care."
NHS England's Stance on Discharge Protocols
A spokesperson for NHS England defended existing practices, asserting that discharge decisions are safe and based on comprehensive clinical assessments. "These figures in isolation are not unusual and clinical guidance including from NICE is clear that BMI should never be used as a sole marker of readiness for discharge," they said. "Patients are only discharged by expert clinicians when they have achieved sufficient progress in their weight, eating patterns and a range of other factors, and with support plans for recovery."
Despite this, Dr David Viljoen, a consultant clinical psychologist at private provider Ellern Mede, expressed concern over discharges below BMI 15, warning it contradicts research evidence and increases risks of relapse, chronic disorders, or premature death.
The revelations underscore ongoing challenges in NHS mental health services, highlighting the need for improved resources and adherence to safety standards in treating eating disorders.
