There can be many reasons why a referral, assessment, or treatment is denied. It is rarely the intention of a clinician to withhold care from someone who needs it, and the Health and Social Care Partnership remains committed to evidence-based practice.
Barriers to care can arise if a clinician does not have the full clinical information about a patient or has not received sufficient training in eating disorders. In some cases, decisions may reflect a service’s local policy or commissioning arrangements.
Regardless of the reason, clinicians should follow the clinical guidelines to ensure that you or your loved one receives eating disorder support in line with best-practice standards.
If in the process of seeking help, you or a loved one is denied treatment for or information about an eating disorder, this page is designed to help you overturn that decision.
Sometimes though, a correct decision about your treatment may feel wrong because it hasn’t been fully explained to you. In such cases, the information on these pages should be useful in helping you to ask for more details. It is not, however, designed to help you overturn clinically appropriate decisions that you disagree with. Decisions can often be challenged when they have gone against clinical guidelines which are considered best-practice.
Regardless of why treatment has been denied, many can be reversed by pointing out the error and asking for a second opinion. A second opinion is when you choose to see another doctor or clinician to ensure that the diagnosis or treatment plan you have been given is correct. While in Northern Ireland there is no legal right to a second opinion, we would expect many clinicians to agree to this.
In most cases, you will be better equipped to challenge decisions if you have good knowledge of the guidelines and eating disorders, but we understand trying to overturn a decision can feel overwhelming. The information on this page will help and our helpline team are happy to guide you towards useful sections if you are not sure where to start.
The information on this page focusses on overturning decisions that have not followed clinical guidelines rather than putting in a complaint about a decision. Whilst we recognise that complaints can be necessary, our priority is to ensure that the best treatment for you or your loved one is provided as quickly as possible in line with the clinical guidelines. There is guidance below on the complaints process if you need it.
This page often refers to different clinical guidelines. Clinical guidelines refer to the recommendations that can help healthcare professionals make informed decisions about patient care. These are often based on the best available evidence which aim to improve the quality of healthcare practices. These can cover a range of physical, neurodevelopmental, and mental health conditions, including eating disorders.
In Northern Ireland, the NICE guidelines (National Institute for Health and Care Excellence) are used. These cover recommendations based on the current evidence for best practice in the management of people with eating disorders. To read the guidelines further, you can head to the NICE guidelines website.
The MEED guidelines (Medical Emergencies in Eating Disorders) are followed across all four nations. These guidelines highlight the importance of reducing medical emergencies in eating disorders and place strong emphasis on comprehensive medical management, which includes both physical and psychiatric care. You can read the full guidelines on the Royal College of Psychiatrists website
The Regional Care Pathway for the Treatment of Eating Disorders highlights the importance of identification, treatment and management of eating disorders within a Northern Ireland context. These can be found on their website.
Sometimes, the process of receiving treatment is called a ‘pathway’. This can start when you first see a healthcare professional, and includes things like being referred for an assessment, and receiving treatment. You might be denied access to treatment or information at any stage of this pathway.
This page covers possible decisions across the pathway. If you, or someone you are supporting, is experiencing one, you will find the information needed here to challenge the decision or understand it better. If the decision that you’re trying to reverse or understand is not listed on this page, please tell us via our online form and we will do what we can to add useful information on this page. You can also contact our Helpline for further support and information around this.
Booking a GP appointment can feel stressful, and sometimes, because of the pressure on GP services, there may be delays. Eating disorders are a serious mental health condition, so it’s important to be seen quickly. You can ask for an urgent or emergency appointment—these are usually same-day, offered on a first-come, first-served basis, and give you the chance to see a professional straight away.
The NICE guidelines for eating disorders recognise the importance of early intervention and how current Health and Social Care Partnership systems and pathways, including long waiting lists, may make delays worse. The NICE guidelines state that healthcare professionals should not use a single measure, such as BMI or duration of an eating disorder, to determine whether to refer you for further support. They also state that if an eating disorder is suspected after an initial assessment, you should be referred immediately to an eating disorder service for further assessment or treatment. Being referred will allow you to get the support and treatment that you, or your loved one, deserves.
The Regional Care Pathway for the Treatment of Eating Disorders echoes the NICE guidelines stating that early identification of an eating disorder is critical, and access to interventions should be offered before harmful behaviours become entrenched. Thus, reducing the seriousness of physical and psychological harm that can occur over time.
The Regional Care Pathway also state that if a GP suspects there is a likelihood of an eating disorder, a referral for a mental health assessment should be provided. It states that referrers should provide individuals and families with interim advice and signpost to voluntary organisations for information and support.
Some GPs have not been trained in eating disorders, however, and therefore aren't aware of how serious they are or know that they require specialist treatment. This may lead to them not making the referral you need. Alternatively, due to service restrictions, some GPs may be unable to refer you for an assessment locally. These restrictions are most often due to commissioning and are not reflective of the help and support you need or deserve. If this is the case, and while they may not be able to, talk to your GP to find out whether they can make an out-of-area referral for you. This is where you get referred into another health board.
What can you do to overturn the decision not to refer you?
Useful tips for the appointment:
Before the appointment, it could be helpful to write the doctor a letter or take along some bullet points about what you’re going through. This will help make sure you say everything you want to say. Here are some things you might want to include:
You might be able to refer yourself to your local mental health or eating disorder service without needing to go through your GP. To find this out, use Beat’s Helpfinder to find your local service and they will usually provide referral information on their website. Alternatively, you can call the service and ask whether they accept self-referrals or whether you need to speak to a GP to refer you.
If you want to complain:
You should be able to find their name on the practice website or on information boards in the surgery or just ask the receptionists and they should be able to provide you their contact details.
While the Practice Manager cannot overturn a decision, they would be the person you would have to speak to if you wanted to complain. This may be keen to help you to receive NICE recommended treatment, to make sure that a complaint isn’t necessary.
You might be denied an assessment, for example, because the service doesn’t offer the treatment you need, or because the service applies exclusion criteria that make it harder for you to get treatment. Being denied an assessment can be extremely disheartening and upsetting, but this does not mean you do not need or deserve the help – it is important that you continue to seek treatment.
NICE Guidance on eating disorders recognises the importance of early intervention for those with an eating disorder and that for those who do not entirely meet formal diagnostic criteria for an eating disorder is to follow guidance for the diagnosis most aligned with their difficulties.
Moreover, NICE has listed a range of Quality Standards for eating disorders. These highlight that people with eating disorders will have higher recovery rates and a reduced risk of relapse when they receive early intervention in eating disorders.
The Regional Care Pathway for the Treatment of Eating Disorders states that when an eating disorder is suspected, a referral to mental health services should be made and a comprehensive mental health assessment should be provided.
What can you do to overturn this decision? (or understand it better)
Decisions to deny you an assessment for having another mental health or a neurodevelopmental condition or being a certain weight can go against the guidelines and therefore are not best practice. Knowing whether a decision is a bad one can be difficult but if you are unsure, do contact our Helpline for information and support.
hYou might be denied treatment, for example, because the service doesn’t offer the treatment you need, or because the service applies exclusion criteria that make it harder for you to get treatment. Being denied treatment can be extremely disheartening and upsetting, but this does not mean you do not need or deserve the help – it is important that you continue to seek treatment.
What you could do to overturn that decision (or understand it better):
Decisions to deny you a treatment for having another mental health condition or being a certain weight can go against the guidelines and therefore are not best practice, according to the NICE guidelines.
Furthermore, the Regional Care Pathway for the Treatment of Eating Disorders states that a formulation is completed collaboratively with the service user while drawing on the expertise of a range of professionals. This means that a detailed understanding should be developed, outlining the person’s difficulties, the potential causes of these difficulties, and how best to treat them. The pathway also states that a personal wellbeing plan (also known as a care or treatment plan) will be developed.
Knowing whether a decision is a bad one can be difficult but if you are unsure, do contact our Helpline for information and support.
If you are living with an eating disorder, you may also be experiencing a physical health condition, another mental health condition, or a neurodevelopmental condition.
In some cases, your local eating disorder service may be able to support you with these additional needs. However, sometimes it may be more appropriate for a specialist service focused on that specific condition to provide care. If your eating disorder or mental health service says they cannot support a particular condition, and no other service is offering help either, this may be a bad decision.
You may also find yourself supported by two different services that are not working together effectively. At times, services may insist that one condition must be treated before you can access support for the other. While this can sometimes be clinically appropriate, it may also be the wrong approach.
The NICE guidelines state that care should be taken to ensure that services are well coordinated when more than one service in involved and that eating disorder specialists and healthcare teams should collaborate to support the effective treatment of physical and mental health co-existing conditions in people with an eating disorder.
NICE Quality Standards recommend services that when people with eating disorders are being supported by more than one service, a care plan should outline how the services will work together as a lack of coordination between services can cause confusion and have the potential to delay recovery.
This is further echoes by the Regional Care Pathway for the Treatment of Eating Disorders which states that an individual can appropriately be using a range of services at the same time. It also states that due to the nature of eating disorders, there is a high likelihood that individuals will require physical and mental health treatment. Therefore, healthcare professionals should be working closely together to ensure joint up care.
By following the steps below, you can explore whether the decisions made about your care are the best ones.
Most transitions within eating disorder services are patients moving from children and young people’s services to adults' services. Transitions between services can be difficult as doctors or healthcare professionals and treatments will likely change. Nevertheless, they can be managed well if everyone communicates effectively.
The NICE guidelines state that particular care should be given surrounding transitions between young-people's services and adult services to ensure that they are well coordinated and properly managed.
The NICE Quality Standards outline how care should be taken for those moving between services and highlights that poor communication can lead to inconsistencies in messages but also management. They call for transition protocols to be followed which will ensure that treatment and support is not compromised by the transition.
The NICE Guidelines on Transitions state that the individual is considered and that the young person is considered an equal partner in the process where their views and needs are taken into account. If appropriate, the person’s family members or carers can be included in this. Furthermore, a ‘named worker’ should be provided to coordinate at least 6 months before the transfer. They should be leading the transition and ensure that the new team is working together to ensure a smooth and gradual transition.
Furthermore, the Regional Care Pathway for the Treatment of Eating Disorders states that eating disorder staff should work closely with the individual, their nominated family/friends and staff from other services to ensure that any transition occurs smoothly and continues to support the individual’s recovery.
The Pathway also states that is a young person requires ongoing treatment after their 18th birthday there will be a planned transfer to adult services. If the young person is 17 when they are first referred, the child and adolescent mental health and adult eating disorder teams should make a clinical decision as to which team is best for that individual.
What you could do to overturn this decision (or ensure the guidance is being followed):
There are several reasons you might transition between services, such as moving away for university, work, or personal reasons. If you remain within the same health board, you can usually continue with the same service. However, if you move to a different health board, you will need to transfer to another service. These transitions can be challenging, as your healthcare professionals and treatments may change, but they can be managed well with clear communication. Importantly, if you are still struggling with your eating disorder, your current service should not discharge you until you have been successfully transitioned to a new service that can continue your care.
The NICE Guidelines for eating disorders highlight the importance of services taking particular care to ensure that services are well coordinated when people need care in different locations.
The NICE Quality Standards outlines how care should be taken for those moving between services and highlights that poor communication can lead to inconsistencies in messages but also management. They call for transition protocols to be followed which will ensure that treatment and support is not compromised by the transition.
The Regional Care Pathway for the Treatment of Eating Disorders states that eating disorder staff should work closely with the individual, their nominated family/friends and the staff from other service areas to ensure that transitions occur smoothly and continues to support the individual’s recovery. They also state that when moving between trusts it says that the timing of the transfer should be based on the individual’s clinical needs and a discussion and agreement between the services as well as the individual concerned.
The Royal College of Psychiatrists which covers all four nations in the UK has also produced guidance for good practice in managing transitions. However, sometimes this isn’t followed. To make sure you are getting the information and support you need during a transition, you may want to follow the below:
hMoving to inpatient care can seem scary, especially if you have not been provided information about your new type of support. Transitions between services can be difficult as healthcare professionals and treatments will likely change. Nevertheless, they can be managed well if everyone communicates effectively.
The NICE guidelines for eating disorders explain that when a person is admitted to inpatient care, specialist eating disorder services should keep in contact with the inpatient team to advise on care and management, both during the admission and when planning discharge.
A care plan should be developed for each person with an eating disorder who is admitted to inpatient care which gives clear objectives and outcomes for the admission, how they will be discharged and how they will move back to community-based care. Importantly, within one month of admission, there should be a review with the patient, their carers, and the referring team of whether inpatient care should be continued or stepped down to a less intensive setting. This may include day patient support or intensive community treatment.
The NICE Guideline on Transitions sets out that the needs and wishes of the person should be recorded at each stage of transition planning and review. It highlights the importance of people being allowed to maintain links with their home community, especially if people are in mental health units outside the area in which they live.
The Regional Care Pathway for the Treatment of Eating Disorders also states that eating disorder staff should work closely with the individual, their nominated family/friends and staff from other services to ensure a smooth transition and the individual’s needs are continued to be supported. Furthermore, it states that during any inpatient admission principle clinical responsibility will be with the inpatient consultant and clinical staff within the hospital. Where needed, the eating disorder service should be providing expert advice to the inpatient team.
The Royal College of Psychiatrists which covers all four nations has produced guidance for good practice in managing transitions. However, sometimes this isn’t followed. To make sure you are getting the information and support you need during a transition, you may want to follow the below:
Leaving inpatient care can seem scary, especially if you have not been provided information about your new type of support. Transitions between services can be difficult as healthcare professionals and treatments will likely change. Nevertheless, they can be managed well if everyone communicates effectively.
The NICE guidelines for eating disorders explain that when a person is admitted to inpatient care, specialist eating disorder services should keep in contact with the inpatient team to advise on care and management, both during the admission and when planning discharge. Furthermore, a care plan should have been developed which will outline how they will move the patient back to community-based care.
The guidelines also state that inpatient services should collaborative with other teams, including the eating disorder service, to help with the transition.
The NICE Guideline on Transitions expects that if more than one team is involved in a person’s transition, ongoing communication between the inpatient and relevant teams should be happening. Furthermore, it is expected that discharge is planned with the person and their carers (if appropriate) and so that the person does not feel their discharge is sudden or premature.
A care plan should be developed for each person with an eating disorder who is admitted to inpatient care which gives clear objectives and outcomes for the admission, how they will be discharged and how they will move back to community-based care. Importantly, within one month of admission, there should be a review with the patient, their carers, and the referring team of whether inpatient care should be continued or stepped down to a less intensive setting. This may include day patient support or community treatment . Upon discharge from the hospital, clinical responsibility should then be transferred back to the community eating disorder team or specialist practitioner.
The Royal College of Psychiatrists which covers all four nations has also produced guidance for good practice in managing transitions. However, sometimes this isn’t followed. To make sure you are getting the information and support you need during a transition, you may want to follow the below:
The NICE guidelines (National Institute for Health and Care Excellence) are used in Northern Ireland which cover recommendations based on the current evidence for best practice in the management of people with eating disorders. To read the guidelines further, you can head to the NICE guidelines website.
The Regional Care Pathway for the Treatment of Eating Disorders also outlines what people can expect if they are referred for treatment and provides a summary of the clinical advice derived from evidence based best practice.
There might be a good reason your service is offering a different treatment to the one recommended in the guidelines, but it might also be the result of under-staffing or cost-saving. If this is the case, you still deserve treatment in line with best practice and to be given an opportunity to share your opinions.
Under Section 75 of the Northern Ireland Act (1998) it is required for public authorities, such as the Health and Social Care Partnership, to consider the impact of their decisions on the nine equality categories: religious belief, sexual orientation, political opinion, gender, racial group, disability (those with a disability and those without), age, dependency (those with dependants and those without) and marital status.
There are a number of legal and policy frameworks, such as the Race Quality Framework, that emphasise the importance of public services, such as the Health and Social Care Partnership, ensuring that members of diverse communities have access to good-quality care and treatment.
The NICE Quality Standards state that considerations should be made for equality and diversity. Care planning should take into account the individual needs of the Individual with the eating disorder and that they should be supplied in a format that suits the person’s needs and preferences.
Furthermore, the quality standards explain that they should be culturally, age and gender appropriate and should be accessible to those who do not speak or read English. If an interpreter or advocate is needed, people should be able to access these.
If you feel as though your protected characteristics are not being considered in services, you may choose to follow the below steps:
No one should be discriminated against for any reason. If you feel as though you are being discriminated against within your healthcare, the Equality Commission for Northern Ireland has information and advice you can take by heading to the Equality NI website. There is also further information on your rights in healthcare listed on the government’s website.
The NICE Guidelines state that if you are starting or already receiving treatment, you should have the chance to share your views about your care. You and your healthcare professionals should work together to make joint decisions about the support you receive. Some, however, feel they are not given a choice, and that decisions about their care are made for them without the opportunity to share their views.
The Regional Care Pathway for the Treatment of Eating Disorders states that one of the recovery principles is to encourage participation and that eating disorder services should support the individual in directing their own care as well as helping them strengthen family, social and community networks. It also states that services will provide interventions and partner with the individual to ensure their preferences, values, ambitions and goals are incorporated into their recovery plan.
If you haven’t been given the opportunity to share your views, you may choose to do the below:
Accessing information and support about your loved one’s eating disorder can be invaluable, offering both reassurance and understanding. Below, we outline the information and support you are entitled to as a carer. You can also find further resources on our website, and our Helpline team is available to provide support and information as well.
The NICE Guidelines state that when assessing a person for an eating disorder, what they and their carers know about eating disorders should be addressed. Furthermore, they explain that when communicating with the person with the eating disorder, their family members or carers may feel guilty and responsible for the eating disorder. In the case that a loved one is admitted to inpatient care, the service should still keep the family members or carers involved to help with treatment and transition.
The NICE Guidelines on Supporting Adult Carers, states that when services provide information, it should be plainly worded, clearly presentation and that carers should be given the opportunity to ask questions. This guideline also outlines that information and support should be provided and that carers should also have the opportunity to discuss their own needs separately from the person they are supporting.
A carer’s assessment can be provided by services which gives you the opportunity to tell social services about the things that could make looking after your loved one easier for you. More on this can be found on Contact's website.
The same guidance outlines carer training programmes should be offered to improve knowledge and coping skills of how to meet the needs of your loved one. In some instances, psychosocial and psychoeducational support can be provided which should include ways of how you can develop strategies and advice on how to look after your own mental health.
The Regional Care Pathway states that during the process of diagnosis, the opinions of family members will be taken into account. The pathway also explains that family members should be offered advice and information so that they can support their loved one.
It is important to note that guidelines also mention the importance of confidentiality for those with eating disorders. This means that not all information will be shared with parents and carers. For example, what a loved one discusses with their therapist will not be shared or if they refuse a particular treatment. Doctors or other healthcare professionals, however, will likely share information about safeguarding concerns with parents and carers. Despite policy and confidentiality, the guidelines are on your side and highlight the importance of parents and carers being offered information and support.
Sometimes though, families and carers are still not offered the information and support to which they are entitled. There are things that you can do to help you overturn that decision:
The Patient and Client Council (PCC) have a remit which includes helping you resolve concerns or problems when using the Health and Social Care Northern Ireland (HSCNI), telling you how to get more involved in your own healthcare and providing information on the Health and Social Care Partnership and their complaints procedure.
When contacting the PCC, you can say that you want the decision that have been made reversing quickly so you or your loved one can get the treatment they need in accordance with the NICE Guidelines and Regional Care Pathway guidance. Ask them to speak to the appropriate doctor or other healthcare professional to reverse the decision.
You can contact the PCC by heading to the PCC website.
A concise letter will be more effective and get a quicker response. You could say that you don’t want to complain but just want the decision reversing so you or your loved one can get the treatment they need and that the guidelines state you (or your loved one) should receive. Ask them to ask the appropriate doctor or other healthcare professional to reverse the decision.
You can find the name of the Chief Executive on the Health Board web site (try the ‘about us’ or ‘corporate information’ sections), or on information boards in hospitals, or through an internet search.
Whilst contacting your local politician representative may seem daunting, they often welcome the opportunity to support constituents with specific difficulties, particularly if they can achieve a result. An intervention from the local politician may therefore help your GP, Trust, Health Board or eating disorder service to reconsider a decision.
Most politicians hold regular surgeries in their constituencies, commonly on Fridays, where you can ask them to intervene on your behalf. In Northern Ireland, you can contact your MLA (Member of the Legislative Assembly). Each region of Northern Ireland has five MLA so you can choose with MLA you would prefer to contact. To find the email address and phone number of your MLAs, head to the NI Assembly website.
When contacting your MLA by email or phone, you may wish to share or mention the following so that your politician and Beat can work together to ensure you get the support you, or your loved one, deserves in line with the clinical guidelines:
"Beat is an organisation that provides support and information about eating disorders. One of their services is a politician advisory service that helps people challenge decisions that do not align with clinical guidelines. Through this service, politicians can seek guidance on how to contest these decisions and understand what the guidelines recommend so that they can help their constituents access care and treatment. Their website and sign-up form can be found on the Beat website"
If you've not been able to overturn a bad decision, you may wish to make a formal complaint. The Health and Social Care Partnership’s complaints process can differ depending on what service you are complaining about which is outlined on the NI Direct website.
If you are wanting to complain about a doctor or healthcare professional in a GP practice, you can contact the Practice Manager. You will usually find their name and email address on the practice website. Alternatively, you can call up the practice and the receptionist will be able to tell you these details.
Remember, the PCC can also provide a freephone support service to support those with questions, concerns of complaints they have within their health and social care.
If your complaint remains unresolved, the final stage is to take it to the health ombudsman. They are an independent service which can make final decisions about a complaint, and they may make recommendations for an organisation, such as the Health and Social Care Partnership, to correct their actions.
Remember, if at any point you ned support or information surrounding the decisions that a service or doctor or other healthcare professional has made, do contact our Helpline team. If you have any feedback about this page or if this page has helped you overturn a decision, please let us know via our online form.