Article: Warning after woman dies due to 'lack of dieticians' in NHS mental health hospital

I’ve met too many doctors and nurses that are in no way able to realize that a patient that haven’t been eating or drinking is in fact in meed of nutrition support. «They’ll eat when they’re hungry enough».

And for that matter, you shouldn’t just try to fix it asap, there are people admitted for anorexia nevrosa that die of renutrition syndrome when staff starts renutrition without consulting the experts. And staff at an eating disorder ward should be familiar with the condition in the first place.

The idea that the missing piece here is a dietitian seems pretty silly and very obviously incorrect to me. This is a whole-system failure, as most failures of this type appear to be, in the form of a competent system being essentially non-existent.

From the full report:

The consultant psychiatrist and anaesthetist did not have satisfactory medical information for Neeshat prior to the ECT treatment on 13.12.22, and so postponement was not considered in light of this.

On further questioning of the Trust’s Clinical Director, I heard evidence that SPFT’s lack of funding for a dietetic resource extends to Trusts nationwide and that this is not a local problem experienced by this Trust alone.

My concern is that severely mentally unwell patients such as Neeshat who was sectioned under s2 Mental Health Act 1983 are not receiving dietary and nutritional support from a qualified dietician when experiencing difficulties in eating and drinking.

What a terrible case. Sounds like all the staff failed here. How did the consultant pychiatrist not have satisfactory medical info two weeks after she had been admitted? It's their job.

Nurses or healthcare assistants were seeing her at every mealtime and there should have been alarm bells ringing. A MUST score is very quick for nurses to tot up and flag to the psychiatrist in charge. Even though the hospital couldn't afford to have its own dietician, surely they could have gotten a private one in to see her at least twice? If there was no funding for that, she might have had family willing to pay for it.

Before a hospital admission, I had only been able to eat about 1/3 of what I usually ate for 2 months and had lost a lot of weight. My BMI was 15 (well into the underweight range). And the admission entailed a fair amount of fasting and prep for tests. One evening I had a scary episode where I felt tingly and was shaking all over. I really wonder if something was up with my electrolyte balance or something like that, because that had never happened before, and thankfully has not happened since. I was on IV fluids for much of the admission, and was able to drink orally, but my food intake was even less than it had been at home because the kitchen struggled to give me what I needed and I was fasting a lot.

When I asked if I could be seen by a dietician, it was a complete surprise to the doctor. They had never tried to refer to a dietician, and didn't know if there was one in the hospital (which was private). There wasn't one.

I felt half-crazed with hunger when I couldn't eat enough. I was very lucky that with domperidone and an iron infusion (unclear if one or the other or both were helpful), I began to be able to eat more, and then normal amounts, but I still didn't put on weight. So I paid for a private dietician and gorged myself back out of the underweight range.

I very much hope psychiatry will start realising that they need to do better on nutrition.

Edit: realised I should clarify that my admission and eating difficulty was nothing to do with anything psychiatric. The ignorance about nutrition is not limited to psychiatry. Though it seems possible it's more pronounced there.

I very much hope psychiatry will start realising that they need to do better on nutrition.

Edit: realised I should clarify that my admission and eating difficulty was nothing to do with anything psychiatric. The ignorance about nutrition is not limited to psychiatry. Though it seems possible it's more pronounced there.

This. Nutritional status should be as basic a piece of info as blood pressure, temperature, etc. It cuts across all health conditions. Sub-par nutrition is going to make everything worse.

This. Nutritional status should be as basic a piece of info as blood pressure, temperature, etc. It cuts across all health conditions. Sub-par nutrition is going to make everything worse.

In Norway it's supposed to be assessed at regular intervals. At one hospital I've been at practice didn't improve until a surgeon started to refuse operating on patients without knowing their nutritional status (and it had to be adequate). It's a sad state of affairs really when as you say sub-par nutrition is going to make everything worse.

In Norway it's supposed to be assessed at regular intervals. At one hospital I've been at practice didn't improve until a surgeon started to refuse operating on patients without knowing their nutritional status (and it had to be adequate). It's a sad state of affairs really when as you say sub-par nutrition is going to make everything worse.

Well this article absolutely underlines how important that was for him to do and how inappropriate it was for anyone to expect him to do any different, how awful for a surgeon or anaesthetist to hand the risk/dilemma to them

The worry is that the way the world is going people just think the answer is that the patient doesn’t get the op they need because in their head they don’t see it as their responsibility to provide the nutrition support in good time to make it possible if they can just get away with saying ‘the patient didn’t fit the system’ etc