From the Guidelines
Eating disorder patients should be detained and require a Mental Health Act assessment when their condition poses a significant risk to their physical health, such as a BMI below 13-14 kg/m², rapid weight loss, or life-threatening medical complications, and they refuse necessary treatment, as recommended by the American Psychiatric Association 1.
Key Considerations for Detention
- Severe physical health risks due to the eating disorder
- Refusal of necessary treatment despite significant medical risk
- Lack of insight into the severity of the condition
- Rapid weight loss (more than 1kg per week)
- Life-threatening medical complications (severe electrolyte imbalances, cardiac abnormalities, or organ failure)
Assessment Process
The assessment process involves mental health professionals evaluating whether the patient has a mental disorder warranting detention, whether they pose a risk to themselves, and if treatment cannot be provided without detention, as outlined in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1.
Goal of Intervention
The goal of detention is to stabilize the patient medically and transition them to less restrictive care as soon as their condition allows, while balancing the duty to prevent harm with respect for patient autonomy, as emphasized in the guideline 1.
From the Research
Detention and Mental Health Act Assessment for Eating Disorder Patients
- Eating disorder patients may be detained under the Mental Health Act when their condition is severe and they are resistant to treatment 2.
- The decision to detain a patient is typically made by a clinician and is based on the patient's risk to themselves or others 3.
- Patients with anorexia nervosa are often detained under the Mental Health Act, and their experiences of detention can be complex and nuanced 2.
- Research has shown that detained patients with anorexia nervosa may have mixed feelings about their hospital admission, and may engage in a "battle" with clinicians or withdraw into a "bubble" 2.
- Studies have compared the outcomes of patients treated under parental consent with those detained under the Mental Health Act, and found that detained patients may have more severe symptoms and poorer psychosocial functioning at admission, but may still achieve significant improvements in physical and psychosocial measures by discharge 4.
Factors Influencing Detention and Mental Health Act Assessment
- The severity of the eating disorder, including the presence of co-morbid depression and suicidal behavior, may influence the decision to detain a patient under the Mental Health Act 4.
- The age of onset and previous hospitalization may also be factors in the decision to detain a patient 4.
- The use of compulsory treatment in eating disorders is a complex and controversial issue, and there is ongoing debate about its effectiveness and potential harms 3.
- Further research is needed to develop clear guidelines for the use of compulsory treatment in eating disorders, and to minimize the use of coercion and promote trusting relationships between patients and clinicians 3.