Pros and cons of using the mental health act for severe eating Disorders in Adolescents

• Published in: European eating disorders review 2009-01, Vol.17 (1), p.14-23
• Main Authors: Ayton, Agnes, Keen, Catherine, Lask, Bryan
• Format: Article
• Language: English
• Subjects: Adolescent; adolescents; Age of Onset; Child Behavior Disorders - classification; Child Behavior Disorders - psychology; Child Behavior Disorders - rehabilitation; compulsory treatment; Diagnostic and Statistical Manual of Mental Disorders; Discharge; Eating disorders; England; Feeding and Eating Disorders - mortality; Feeding and Eating Disorders - psychology; Feeding and Eating Disorders - rehabilitation; Humans; Informed consent; Length of Stay; Medical treatment; Mental Health Services - legislation & jurisprudence; outcome research; parental consent; Psychiatric Status Rating Scales; Psychological Tests; Survival Analysis; Teenagers; Treatment Outcome; Wales; Weight Gain
• ISSN: 1072-4133; 1099-0968
• DOI: 10.1002/erv.887

Background In England and Wales the compulsory treatment of young people with severe eating disorders is controversial. There is a concern that such treatment may impair patient autonomy and negatively influence the outcome. In this study, based in a specialist hospital, we compared patients treated under parental consent with those detained under the Mental Health Act: their characteristics and outcome up to 12 months after discharge. Results 34 patients were informal (treated under parental consent) (age: 16.2 ± 1.3 years) and 16 were treated under Section 3 of the Mental Health Act (age: 16.2 ± 1) in a 3‐year period. Detained patients had an earlier age of onset (12.2 ± 5 vs. 14.3 ± 1.8) and more previous hospitalisation. On admission, their psychosocial functioning (Children's Global Assessment Scale (C‐GAS): 13.6 ± 2 vs. 26.9 ± 9; Health of the Nation Outcome Scale for Children and Adolescents (HONOSCA): 41.7 ± 5 vs. 31.9 ± 5) were worse than voluntary patients', they had a higher level of co‐morbid depression (BDI: 38.1 ± 15.6 vs. 26.6 ± 12.4) and a higher rate of suicidal behaviour. All physical and psychosocial measures improved substantially and clinically significantly by discharge and there was no statistically significant difference at this stage between the two patient groups. Two informal patients died within a year after discharge (6.3%), but there were no deaths amongst the detained patients. Comments In contrast with previous findings in adults, the outcome for detained patients was similar to that for informal patients, despite the former having more severe presentation on admission. There was no evidence of higher mortality in the detained group. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.