Recognising and managing eating disorders in the emergency department

Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals. This can be due to denial of the condition itself, a wish to avoid treatment for a condition which may be valued, or because of the stigma attached to mental health. As a result their diagnosis can be easily missed by healthcare professionals and thus the prevalence is underappreciated. This article presents eating disorders to emergency and acute medicine practitioners from a new perspective using the combined emergency, psychiatric, nutrition and psychology lens. It focuses on the most serious acute pathology which can develop from the more common presentations; highlights indicators of hidden disease; discusses screening; suggests key acute management considerations and explores the challenge of mental capacity in a group of high-risk patients who, with the right treatment, can make a good recovery.

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Exacerbating risks and diminishing rights for ‘at-risk’ prisoners

Criminology & Criminal Justice ◽

10.1177/1748895817739666 ◽

2017 ◽

Vol 18 (5) ◽

pp. 515-532 ◽

Cited By ~ 1

Author(s):

Alexis Harris ◽

Elizabeth Stanley

Keyword(s):

Mental Health ◽

At Risk ◽

New Zealand ◽

Right To Life ◽

Health Distress ◽

Self Harm ◽

The Right ◽

Mental Health Distress

At-Risk Units (ARUs) are dedicated facilities established in New Zealand prisons to assist those considered to be ‘at risk’ of self-harm or suicide. Their remit is ostensibly care-based and rights-conscious, with authorities noting that ARUs preserve the ‘right to life’. Drawing upon research within two correctional sites, alongside analysis of recent documents from oversight bodies and courts, this article considers ARU operations. It is argued that, all too often, ARUs have undermined humane practices towards suicidal or ‘at-risk’ prisoners. Four problems are apparent: (1) ARUs are misused and overused in such a way that secure punishment, rather than care, is prioritized; (2) within a context of ‘lesser eligibility’, ARUs operationalize degrading conditions and treatments towards prisoners; (3) humane treatments are further diminished by a correctional approach to prioritize legal or bureaucratic compliance; and (4) authorities avoid institutional sanction for prisoner harms or deaths, particularly through an emphasis on personal responsibilization or blame. The end-result is that ARUs are regularly operationalized in ways that exacerbate risks and diminish rights for prisoners. A question remains about their fundamental use as an appropriate response to those who suffer mental health distress within penal environments.

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Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study

Journal of Medical Internet Research ◽

10.2196/19532 ◽

2021 ◽

Vol 23 (2) ◽

pp. e19532

Author(s):

Alyssa Clare Milton ◽

Ashlea Hambleton ◽

Mitchell Dowling ◽

Anna Elizabeth Roberts ◽

Tracey Davenport ◽

...

Keyword(s):

Mental Health ◽

Eating Disorders ◽

Body Image ◽

Participatory Design ◽

Technological Solution ◽

Web Based ◽

Design Processes ◽

The Right ◽

Body Image Issues ◽

Technology Solution

Background The recent Australian National Agenda for Eating Disorders highlights the role technology can play in improving accessibility and service development through web-based prevention, early access pathways, self-help, and recovery assistance. However, engagement with the eating disorders community to co-design, build, and evaluate these much-needed technology solutions through participatory design processes has been lacking and, until recently, underresourced. Objective This study aims to customize and configure a technology solution for a nontraditional (web-based, phone, email) mental health service that provides support for eating disorders and body image issues through the use of participatory design processes. Methods Participants were recruited chiefly through the Butterfly National Helpline 1800 ED HOPE (Butterfly’s National Helpline), an Australian-wide helpline supporting anyone concerned by an eating disorder or body image issue. Participants included individuals with lived experience of eating disorders and body image issues, their supportive others (such as family, health professionals, support workers), and staff of the Butterfly Foundation. Participants took part in participatory design workshops, running up to four hours, which were held nationally in urban and regional locations. The workshop agenda followed an established process of discovery, evaluation, and prototyping. Workshop activities included open and prompted discussion, reviewing working prototypes, creating descriptive artifacts, and developing user journeys. Workshop artifacts were used in a knowledge translation process, which identified key learnings to inform user journeys, user personas, and the customization and configuration of the InnoWell Platform for Butterfly’s National Helpline. Further, key themes were identified using thematic techniques and coded in NVivo 12 software. Results Six participatory design workshops were held, of which 45 participants took part. Participants highlighted that there is a critical need to address some of the barriers to care, particularly in regional and rural areas. The workshops highlighted seven overarching qualitative themes: identified barriers to care within the current system; need for people to be able to access the right care anywhere, anytime; recommendations for the technological solution (ie, InnoWell Platform features and functionality); need for communication, coordination, and integration of a technological solution embedded in Butterfly’s National Helpline; need to consider engagement and tone within the technological solution; identified challenges and areas to consider when implementing a technological solution in the Helpline; and potential outcomes of the technological solution embedded in the Helpline relating to system and service reform. Ultimately, this technology solution should ensure that the right care is provided to individuals the first time. Conclusions Our findings highlight the value of actively engaging stakeholders in participatory design processes for the customization and configuration of new technologies. End users can highlight the critical areas of need, which can be used as a catalyst for reform through the implementation of these technologies in nontraditional services.

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Perinatal mental health

Obstetric Medicine ◽

10.1093/med/9780198821540.003.0016 ◽

2020 ◽

pp. 521-564

Author(s):

Charlotte Frise ◽

Sally Collins

Keyword(s):

Mental Health ◽

Substance Abuse ◽

Eating Disorders ◽

Mental Health Problems ◽

Perinatal Mental Health ◽

Mother And Baby Unit ◽

Specific Phobias ◽

Self Harm ◽

In Pregnancy

This chapter covers perinatal mental health problems, both those that develop in pregnancy and those that may be encountered as pre-existing when a patient becomes pregnant. Specific phobias relating to the state of being pregnant (tocophobia) or issues encountered in pregnancy (blood, injury, and injection phobia), as well as depression, schizophrenia, eating disorders, self-harm, and substance abuse are covered. Treatment without consent and the role of the mother and baby unit are discussed.

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Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study (Preprint)

10.2196/preprints.19532 ◽

2020 ◽

Author(s):

Alyssa Clare Milton ◽

Ashlea Hambleton ◽

Mitchell Dowling ◽

Anna Elizabeth Roberts ◽

Tracey Davenport ◽

...

Keyword(s):

Mental Health ◽

Eating Disorders ◽

Body Image ◽

Participatory Design ◽

Technological Solution ◽

Web Based ◽

Design Processes ◽

The Right ◽

Body Image Issues ◽

Technology Solution

BACKGROUND The recent Australian National Agenda for Eating Disorders highlights the role technology can play in improving accessibility and service development through web-based prevention, early access pathways, self-help, and recovery assistance. However, engagement with the eating disorders community to co-design, build, and evaluate these much-needed technology solutions through participatory design processes has been lacking and, until recently, underresourced. OBJECTIVE This study aims to customize and configure a technology solution for a nontraditional (web-based, phone, email) mental health service that provides support for eating disorders and body image issues through the use of participatory design processes. METHODS Participants were recruited chiefly through the Butterfly National Helpline 1800 ED HOPE (Butterfly’s National Helpline), an Australian-wide helpline supporting anyone concerned by an eating disorder or body image issue. Participants included individuals with lived experience of eating disorders and body image issues, their supportive others (such as family, health professionals, support workers), and staff of the Butterfly Foundation. Participants took part in participatory design workshops, running up to four hours, which were held nationally in urban and regional locations. The workshop agenda followed an established process of discovery, evaluation, and prototyping. Workshop activities included open and prompted discussion, reviewing working prototypes, creating descriptive artifacts, and developing user journeys. Workshop artifacts were used in a knowledge translation process, which identified key learnings to inform user journeys, user personas, and the customization and configuration of the InnoWell Platform for Butterfly’s National Helpline. Further, key themes were identified using thematic techniques and coded in NVivo 12 software. RESULTS Six participatory design workshops were held, of which 45 participants took part. Participants highlighted that there is a critical need to address some of the barriers to care, particularly in regional and rural areas. The workshops highlighted seven overarching qualitative themes: identified barriers to care within the current system; need for people to be able to access the right care anywhere, anytime; recommendations for the technological solution (ie, InnoWell Platform features and functionality); need for communication, coordination, and integration of a technological solution embedded in Butterfly’s National Helpline; need to consider engagement and tone within the technological solution; identified challenges and areas to consider when implementing a technological solution in the Helpline; and potential outcomes of the technological solution embedded in the Helpline relating to system and service reform. Ultimately, this technology solution should ensure that the right care is provided to individuals the first time. CONCLUSIONS Our findings highlight the value of actively engaging stakeholders in participatory design processes for the customization and configuration of new technologies. End users can highlight the critical areas of need, which can be used as a catalyst for reform through the implementation of these technologies in nontraditional services.

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Child Health Clinical Outcome Review Programme: Health Care Utilisation, Care Pathways and Educational Status in Children and Young People with Adolescent Mental Health problems with a focus on Self harm, Eating Disorders and Anxiety and Depression

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.130 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Sophie Wood ◽

Ann John ◽

Alison Kemp ◽

Bethan Carter ◽

Melissa Wright

Keyword(s):

Mental Health ◽

Health Care ◽

Eating Disorders ◽

Healthcare Utilisation ◽

Adolescent Mental Health ◽

Health Care Utilisation ◽

Care Utilisation ◽

Health And Social Care ◽

Self Harm ◽

The Uk

ABSTRACT ObjectivesTo use routinely collected datasets and data linkage to identify patterns of healthcare utilisation by children and young people (CYP) with adolescent mental health (AMH) disorders across the four UK Nations, with a particular focus on self-harm, anxiety and depression and eating disorders. The analysis will focus on healthcare utilisation during transition from child to adult services and, where possible, on the interface between different care settings e.g. primary and secondary care and health and social care. In addition we will determine the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that CYP with AMH disorders receive. ApproachData has been requested from the national data providers in each country: The Health and Social Care Information Centre - England The Secure Anonymised Information Linkage (SAIL) databank - Wales Information Services Division – Scotland The Honest Broker Service- Northern Ireland As well as other sources: The Clinical Practice Research Datalink The Paediatric Intensive Care Audit Network. A number of restrictions and information governance regulations have had to be negotiated and put in place in order to access and store the data in the SAIL Databank, Swansea University. Descriptive cross sectional analysis is underway to address the key questions. RationalThe project has arisen from the report ‘Overview of Child Deaths in Four UK Countries’ which found that 30-40% of 13-18 year olds were affected by mental health, learning difficulties or behavioural conditions. The diagnosis, management and services available for mental disorders in CYP are of growing concern and a source of controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services, as well as, that between the NHS and other sectors is often disjointed. Thresholds for referral to Child and Adolescent Mental Health Services (CAMHS) are high and many adolescents are treated, at least initially, in primary health care systems. ImplicationsAnalysis of routinely collected health datasets has the potential to describe the nature and extent of health needs and health care utilisation for CYP with AMH disorders (self-harm, depression/anxiety, eating disorders). Furthermore the knowledge obtained from using routinely collected healthcare data, will inform future routine data collection across the UK for CYP with AMH disorders.

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Ethical Issues in the Care of Adolescents

10.1093/med/9780199354474.003.0008 ◽

2016 ◽

Author(s):

Alan R. Fleischman

Keyword(s):

Mental Health ◽

Decision Making ◽

Eating Disorders ◽

Ethical Issues ◽

Adolescent Patient ◽

Truth Telling ◽

Ethical Concerns ◽

Self Harm ◽

Relationship Of ◽

The Relationship

This chapter describes the dramatic physical and emotional changes that occur during adolescence. It examines the concept of evolving autonomy as young teens begin to develop the capacity to participate fully in decision-making for their care. Ethical issues concerning the relationship of an adolescent patient and his or her parents, including confidentiality and truth telling are discussed. The chapter focuses on empowering adolescents to take responsibility for their health and their healthcare. Ethical concerns for the adolescent with no family, the homosexual and transgender adolescent, and the adolescent with mental health, behavior problems, and eating disorders are all examined.The role and limits of patient confidentiality are discussed, particularly in terms of patient self-harm.

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Radically open dialectical behaviour therapy adapted for adolescents: a case series

BMC Psychiatry ◽

10.1186/s12888-021-03460-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julian Baudinet ◽

Catherine Stewart ◽

Eleanor Bennett ◽

Anna Konstantellou ◽

Rhian Parham ◽

...

Keyword(s):

Mental Health ◽

Eating Disorders ◽

Case Series ◽

Small Sample ◽

Behaviour Therapy ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Dialectical Behaviour Therapy ◽

Symptoms Of Depression ◽

Self Harm

Abstract Background Overcontrol is a transdiagnostic cluster of traits associated with excessive psychological, behavioural and social inhibitory control. It is associated with psychiatric diagnoses of depression, restrictive eating disorders and/or obsessive-compulsive personality disorder. Radically Open Dialectical Behaviour Therapy is a transdiagnostic treatment for maladaptive overcontrol. This case series evaluates an adolescent adaption (RO-A) for a transdiagnostic group of adolescents identified as overcontrolled. Methods Twenty-eight adolescents were consecutively referred for RO-A from two different National and Specialist Child and Adolescent Mental Health Services between June 2017 and February 2020. Baseline self-report measures assessed overcontrol characteristics, relationship and attachment quality and mental health symptoms of depression and eating disorders, which were repeated at discharge. Results Adolescents in this case series reported high rates of depression (78.6%), self-harm (64.3%) and eating disorders (78.6%). Most (85.7%) had two or more mental health diagnoses and all had previous mental health treatments before starting RO-A. The mean number of RO-A sessions attended was 18 group-based skills classes and 21 individual sessions over a mean period of 34 weeks. Significant improvements with medium and large effect sizes were reported in cognitive flexibility (d = 1.63), risk aversion (d = 1.17), increased reward processing (d = .79) and reduced suppression of emotional expression (d = .72). Adolescents also reported feeling less socially withdrawn (d = .97), more connected to others (d = 1.03), as well as more confident (d = 1.10) and comfortable (d = .85) in attachment relationships. Symptoms of depression (d = .71), eating disorders (d = 1.06) and rates of self-harm (V = .39) also significantly improved. Exploratory correlation analyses suggest improvements in overcontrol are moderately to strongly correlated with improvements in symptoms of depression and eating disorders. Conclusions This case series provides preliminary data that RO-A may be an effective new treatment for adolescents with overcontrol and moderate to severe mental health disorders like depression and eating disorders. RO-A led to improved management of overcontrol, improved relationship quality and reduced mental health symptoms. Further evaluation is indicated by this case series, particularly for underweight young people with eating disorders. More rigorous testing of the model is required as conclusions are only tentative due to the small sample size and methodological limitations.

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