There can be many reasons why a referral, assessment, or treatment is denied. It is rarely the intention of a doctor or healthcare professional to withhold care from someone who needs it, and the NHS remains committed to evidence-based practice.
Barriers to care can arise if a doctor or other healthcare professional 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, healthcare professionals 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 this page should be useful in helping you to ask for more details. However, it’s not 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 review or a second opinion. A second opinion is when you choose to see another doctor or other healthcare professional to ensure that the diagnosis or treatment plan you have been given is correct. NHS Scotland encourages patients to seek second opinions if they have any doubts or concerns about their diagnosis or treatment.
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 the below pages 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 about the complaints process if you need it.
This page often refers to different clinical guidelines. Clinical guidelines refer to the recommendations that can help doctors and other 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 Scotland, the SIGN guidelines (Scottish Intercollegiate Guidelines Network) 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 read them on their 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 Scottish Government has also completed the Scottish National Review of Eating Disorder Services. Whilst these are not clinical guidelines, and cannot be used to challenge a decision, they do call for improved outcomes for those with eating disorders and are recommendations set out by the Scottish Government. The national specification for the care and treatment of eating disorders in Scotland was developed in response to this review, and is available Scotland Government website. It sets out a roadmap for improving eating disorders care.
The NICE (National Institute for Health and Care Excellence) guidelines are followed in England, Wales and Northern Ireland. Though they are also seen as a source of good practice in Scotland and for particular decisions, the NICE guidelines are endorsed for use in Scotland. For example on being involved in decisions about your care. Where this is the case, we will explain below.
Please note that this list is not exhaustive. There are additional guidelines and sources of information relevant to mental health treatment, including the Charter of Patient Rights and Responsibilities, the CAMHS National Specification, and the Mental Health Act . Due to the scope and level of detail within these documents, they are not outlined here; however, you are encouraged to review them if you would like further information.
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 SIGN Guidelines for eating disorders recognise the importance of early intervention and how current NHS systems and pathways, including long waiting lists, may make delays worse. They say that there needs to be an awareness of appropriate responses and referral pathways. This means you should be referred to a mental health service, who may then decide to refer you to an eating disorder team depending on their expertise. Being referred will allow you to get the support and treatment that you, or your loved one, deserves.
The Scottish Eating Disorder Services Review notes that eating disorders thrive in isolation. It says that key stakeholders and healthcare professionals should be able to identify the signs and symptoms of all eating disorders including at early stages and know how to support and signpost people into treatment.
Some GPs haven’t 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, 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:
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.
This may be keen to help you to receive SIGN 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. Or, you might not have been given a reason why. 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.
SIGN Guidance on eating disorders recognises the importance of early intervention for those with an eating disorder. Its advice for those which do not entirely meet formal diagnostic criteria for an eating disorder is to follow guidance for the diagnosis most aligned with their difficulties. It also talks about common issues raised by patients and carers, that the use of weight as a measure of the need for treatment is unhelpful.
What can you do to overturn this decision? (or understand it better)
1. Speak to the person who made the referral about whether a reason was given for your referral being denied. If not, ask them if they can find out.
If they cannot help you, you can contact the eating disorder service directly for a meeting or a telephone conversation, with the doctor or other healthcare professional who responded to your referral or the team manager, to help you understand their decision. We would expect them to agree to talk to you about this. If you’re not comfortable asking for a conversation, write to or email the service and ask for an explanation for why treatment has not been offered. Finding out why they denied you an assessment can be a key in understanding whether it can be challenged.
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 or isn’t in line with guidelines can be difficult but if you are unsure, do contact our Helpline for information and support.
2. Unless you’re happy with the explanation that the healthcare professional or team manager provided, book another appointment with the person who referred you. Show them the explanation and ask them to help you reverse the decision or get a second opinion. Even if you are satisfied with their explanation, you deserve support and continue to seek treatment and your GP may be able to refer you to another service who can provide support to you.
3. Visit Beat's Helpfinder to find a local NHS service that does provide the treatment you need and ask your GP to refer you to that service.
You 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):
1. you can contact the eating disorder service directly for a meeting or a telephone conversation, with the healthcare professional who responded to your referral or the team manager, to help you understand their decision. We would expect them to agree to talk to you about this. If you’re not comfortable asking for a conversation, write to or email the service and ask for an explanation for why treatment has not been offered.
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. Knowing whether a decision is or isn’t in line with guidelines can be difficult but if you are unsure, do contact our Helpline for information and support.
2. Unless you’re happy with the explanation from the healthcare professional who denied you treatment or their team manager, book another appointment with the GP who referred you. Show your GP the explanation and ask them to help you reverse the decision or get a second opinion. Even if you are satisfied with their explanation, still seek treatment as you deserve support and your GP may be able to refer you to another service who can provide support to you.
3. If you are content with their explanation, visit Beat’s Helpfinder to find a local service that does provide the treatment you need, and ask your GP to refer you to that service.
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, either separately or alongside the eating disorder service. 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 not be in line with guidelines.
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 SIGN guidelines state that a holistic and individualised approach to care should be taken and that treatment options should consider therapeutic models that have an established evidence base in the treatment of co-existing conditions. Where a patient has an eating disorder and a personality disorder, different specialist services need to work closely together to prevent either gaps or conflicting goals in the work of each service.
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 healthcare professionals and treatments will likely change. Nevertheless, they can be managed well if everyone communicates effectively.
The SIGN guidelines states that a transition should be prepared, managed and followed up by doctors or healthcare professionals. They also say that a transition co-ordinator should be appointed several months before the transition. The role of the transition coordinator is to supervise the transition and to communicate with all healthcare professionals and services involved. For example, your current service and the adult service. Furthermore, the guidelines also state that a transition plan should be made with input from the patient, healthcare professionals and carers.
The SIGN guidelines also highlight many themes related to transitions: the importance of providing accurate information to patients and parents, the challenges posed by the sharp drop in mental health service attendance after age 18, and the benefits of structured approaches to transitions, such as overlapping services.
The Royal College of Psychiatrists which covers all four nations has produced guidance for good practice in managing transitions. The guidance states that while all-age eating disorder services are becoming more common, which means that no transitions will be required due to age, coverage varies. Most young people are therefore supported by CAMHS (Child and Adolescent Mental Health Services) teams which have an upper age limit. Typically, this will be at the age of 16, 17 or 18. The guidance references the 2006 NHS Quality Improvement Guidelines for Scotland which highlights the importance of services working together to ensure transitions are achieved as smoothly as possible and at the optimum time to best meet the clinical needs of patients
Despite this guidance, it is not always followed. To make sure you are getting the information and support you need during a transition, you may want to follow the below:
If your transition is imminent, for example you are close to turning 18 (or have already turned 18), and no clear plan has been made for your move from children’s to adult eating disorder services, it is understandable to feel anxious. You still have options, and support should not stop suddenly because of your age. You can:
The plan should include information on:
If you are transitioning between services, you should expect to receive contact from the new service. If you have not, you can ask your current service when you will expect to hear from them.
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 doctors 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 SIGN guidelines states that a transition should be prepared, managed and followed up by doctors or other healthcare professionals. They also say that a transition co-ordinator should be appointed several months before the transition. The role of the transition coordinator is to supervise the transition and to communicate with all healthcare professionals and services involved. For example, your current service and the new service. Furthermore, the guidelines also state that a transition plan should be made with input from the patient, healthcare professionals and carers.
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:
Moving 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 SIGN guidelines states that a transition should be prepared, managed and followed up by doctors or other healthcare professionals. They also say that a transition co-ordinator should be appointed several months before the move. Their role is to supervise the transition and to communicate with all healthcare professionals and services involved. Furthermore, the guidelines also state that a transition plan should be made with input from the patient, healthcare professionals and carers.
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.
We recognise that transitions into inpatient services can be quick and while time may be limited to do some of the actions they are expected to do, for instance visiting the inpatient ward before, support should still be in place to manage the transition. This may include offering you information about the inpatient care you will receive and asking you about your viewpoints.
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 doctors or healthcare professionals and treatments will likely change. Nevertheless, they can be managed well if everyone communicates effectively.
The SIGN guidelines states that a transition should be prepared, managed and followed up by doctors or other healthcare professionals and that a transition co-ordinator should be appointed several months before the move. Their role is to supervise the transition and to communicate with all healthcare professionals and services involved. Furthermore, the guidelines also state that a transition plan should be made with input from the patient, healthcare professionals and carers.
The Royal College of Psychiatrists which covers all four nations has produced guidance for good practice in managing transitions. These state that discharge planning should begin early so that professionals, such as your GP, can be identified and kept informed. A formal discharge planning meeting, with clear documentation, can help ensure that everyone understand the plan for ongoing care. This may include creating a relapse prevention plan or an advance statement, which sets out what support you (or the patient) would want if their health deteriorates in the future. The Royal College’s guidance makes it clear that it is important to talk openly about the possibility of relapse and that patients, and their families, should be reassured that support remains available if problems arise in the future. Some services may offer occasional follow-up contact after discharge such as a check-in once or twice a year.
Despite this guidance, sometimes it is not followed. To make sure you are getting the information and support you need during a transition, you may want to follow the below:
The SIGN guidelines (Scottish Intercollegiate Guidelines Network) are used in Scotland 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 SIGN guidelines website.
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.
The government states that it is against the law to discriminate against anyone because of the following: age, gender reassignment, being married or in a civil partnership, being pregnant or on maternity leave, disability, race including colour, nationality, ethnic or national origin, religion or belief, sex or sexual orientation.
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 NHS, ensuring that members of diverse communities have access to good-quality care and treatment.
SIGN guidelines state that services should consider the whole person and the different needs of those seeking care. Doing so can help reduce inappropriate or unequal treatment, improve confidence in services, and provide more compassionate care that restores hope, particularly for people from diverse backgrounds who may face disadvantage, discrimination, or poorer health outcomes.
The SIGN guidance says there is a lack of research into underserved groups and there is a risk that services are then unable to offer appropriate treatments to those who do not match the populations studies. The following groups are mentioned in the SIGN guidelines on eating disorders:
In our opinion, if you think of any accommodations the service could make to ensure you feel more supported, speak to the service and see what they can do.
For further guidance, you can read section 15.4 on the SIGN guidelines.
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 Citizens Advice Bureau has information and advice on steps you can take by heading to their website.
The NICE guidelines (National Institute for Care Excellence) are the SIGN-equivalent for England, Wales and Northern Ireland. Whilst the NICE guidelines are not often used in Scotland, NICE guideline 197 (which is about being involved in decisions about your care) have been endorsed for use in Scotland.
The 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. Sometimes people feel they are not given a choice, and that decisions about their care are made for them without the opportunity to share their views.
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 is available to provide support and information as well.
The SIGN guidelines highlight that parents and carers often experience high levels of distress, and this psychological impact can result in ineffective strategies for managing an eating disorder. Therefore, family and carer support should always be offered if they are not already involved in formal family work. Importantly, support should also be available to parents and carers even if their loved one is not currently accessing services.
The 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. Even with confidentiality and data protection rules, national guidance supports your involvement. You are still entitled to receive support, clear information about eating disorders, and guidance on how to support your loved one. There should also be space for you to talk about how you are coping, and you should be given information about how to access support for yourself as a carer.
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:
We recognise that there is a lack of clear clinical guidance on what support for ARFID should look like and as such, sometimes there are services that do not offer support for those with ARFID. Despite this though, you still deserve support and below are some pieces of information that covers ARFID that you can use when speaking with, or writing to, doctors or other healthcare professionals.
The SIGN Guidelines for eating disorders highlights the lack of ARFID guidance due to the lack of research done in this area, however it has outlined a range of interventions for the treatment of children and adolescents with ARFID which includes family-based treatment, cognitive behavioural therapy, parenting training/coaching and dietetics. It also lists the desired outcomes of these interventions.
The Scottish Government’s Eating Disorder Services Review has outlined a range of principles for their vision of eating disorders which includes the equitability of specialist treatment regardless of diagnosis, weight or other severity measures and that services, including different specialities, work together to support co-existing conditions, putting the patient at the forefront of care. While the services review are not clinical guidelines, it does show a positive direction of travel for eating disorder services in Scotland.
The MEED Guidelines also makes it clear that whilst there is a lack of evidence for “re-feeding” is lacking, those suspected with an eating disorder, including ARFID, should be referred to an eating disorder specialist without delay. These guidelines also state that refeeding someone with ARFID is not a normal part of a parents skill set and so parents will need support to develop their confidence in supporting treatment, such as managing mealtime distress and reinforcing diet plans.
The Patient Advice and Support Service (PASS) have a remit which includes helping you to resolve problems when using the NHS. PASS specifically states that it can help you to access the treatment, care and support you need.
When contacting PASS, 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 and that SIGN says they should receive. Ask them to speak to the appropriate doctor or healthcare professional to reverse the decision.
You can find details of your PASS office by asking at your hospital or GP surgery reception. Alternatively, you can find details of your PASS office on their website.
PASS can also help if you decide to make a formal complaint.
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 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 Scotland, you can contact your MSP (Member of the Scottish Parliament). You will have one constituency MSP and seven regional MSPs. You can choose which MSP you would prefer to contact. You can find the email addresses and phone numbers of your MSPs via the Scottish Parliament website.
When contacting your MSP 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. Beat have an advocacy 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. It can be accessed by filling out this online form.
If you've not been able to overturn a decision, you may wish to make a formal complaint. The NHS complaints process can differ depending on what service you are complaining about.
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.
If you want to complain about a mental health or eating disorder service, you can contact the patients' complaints or patient relations team. You can find their details by heading to the NHS Inform website.
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 NHS, to correct their actions.
Remember, if at any point you ned support or information surrounding the decisions that a service or doctor or 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.