Management of transitions to adult services for young people with eating disorders: survey of current practice in England

Aims and method The Royal College of Psychiatrists has published recommendations for managing transitions between child and adolescent mental health services (CAMHS) and adult services for eating disorders. A self-report questionnaire was designed to establish how many CAMHS teams meet these recommendations and was distributed to 70 teams providing eating disorders treatment in England. Results Of the 38 services that participated, 31 (81.6%) reported a flexible upper age limit for treatment. Only 6 services (15.8%) always transferred young people to a specialist adult eating disorders service and the majority transferred patients to either a specialist service or a community mental health team. Most services complied with recommended provision such as a written transition protocol (52.6%), individualised transition plans (78.9%), joint care with adult services (89.5%) and transition support for the family (73.7%). Clinical implications Services are largely compliant with the recommendations. It is a concern that only a small proportion of services are always able to refer to a specialist adult service and this is likely to be due to a relative lack of investment in adult services.

An acute change? Does treatment within a therapeutic community for personality disorders affect local acute service use

Purpose The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to understand if the use of acute services was also affected via a service evaluation project. Design/methodology/approach The authors collected data from electronic records on the use of local services in the two years before, during and the two years after treatment in the TC. Specifically, the authors counted inpatient bed days, Emergency department (ED) presentations and days under home treatment team and liaison psychiatry; the authors used ANOVA to analyse the data. Findings The study included 25 adult service users, 17 female and 8 male, with an average age of 40. Whilst there were reductions in the use of inpatient beds and ED presentations, on analysis, these were not found statistically significant. The small size of the study is a limitation and may limit the generalisability of the findings. The study concludes there may be reductions in acute psychiatric service use during and after treatment in the TC. The findings were not statistically significant; the authors suggest larger multi-centre studies may be able to demonstrate statistical significance. Originality/value PD patients have a relatively high use of acute psychiatric services compared to other patient groups. The authors are not aware of any similar studies in the published literature.

Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants?

IntroductionThe UK is the only permanent member of the UN Security Council that has a policy of recruiting 16 and 17 year old individuals into its regular Armed Forces. Little is known about the consequences of enlisting as a Junior Entrant (JE), although concerns have been expressed. We compare the mental health, deployment history, and pre-enlistment and post-enlistment experiences of personnel who had enlisted as JEs with personnel who joined as Standard Entrants (SEs).MethodParticipants from a large UK military cohort study completed a self-report questionnaire between 2014 and 2016 that included symptoms of probable post-traumatic stress disorder (PTSD), common mental disorders, alcohol consumption, physical symptoms and lifetime self-harm. Data from regular non-officer participants (n=4447) from all service branches were used in the analysis. JEs were defined as having enlisted before the age of 17.5 years. A subgroup analysis of participants who had joined or commenced adult service after April 2003 was carried out.ResultsJEs were not more likely to deploy to Iraq or Afghanistan but were more likely to hold a combat role when they did (OR 1.25, 95% CI 1.00 to 1.56). There was no evidence of an increase in symptoms of common mental disorders, PTSD, multiple somatic symptoms (MSS), alcohol misuse or self-harm in JEs in the full sample, but there was an increase in alcohol misuse (OR 1.84, 95% CI 1.18 to 2.87), MSS (OR 1.51, 95% CI 1.04 to 2.20) and self-harm (OR 2.13, 95% CI 1.15 to 3.95) in JEs who had commenced adult service after April 2003. JEs remain in adult service for longer and do not have more difficulties when they leave service.ConclusionsJEs do not have worse mental health than SEs, but there is uncertainty in relation to alcohol misuse, MSS and self-harm in more recent joiners. Monitoring these concerns is advisable.

Implementing a Transition Program from Paediatric to Adult Services in Phenylketonuria: Results After Two Years of Follow-Up with an Adult Team

We aimed to report the implementation of a phenylketonuria (PKU) transition program and study the effects of follow-up with an adult team on metabolic control, adherence, and loss of follow-up. Fifty-five PKU patients were analysed in the study periods (SP): 2 years before (SP1) and after the beginning of adult care (SP2). Retrospective data on metabolic control and number of clinic appointments were collected for each SP, and protein intakes were analysed. In SP2, three patients (6%) were lost to follow-up. There was a small but statistically significant increase in median number of annual blood spots from SP1 to SP2: 11 (7–15) vs. 14 (7–20); p = 0.002. Mean ± SD of median blood Phe remained stable (525 ± 248 µmol/L vs. 552 ± 225 µmol/L; p = 0.100); median % of blood Phe < 480 µmol/L decreased (51 (4–96)% vs. 37 (5–85)%; p = 0.041) and median number of clinic appointments increased from SP1 to SP2: (5 (4–6) vs. 11 (8–13); p < 0.001). No significant differences were found regarding any parameter of protein intake. Our results suggest that the implementation of an adult service was successful as impact on metabolic control was limited and attendance remained high. Continuous dietetic care likely contributed to these results by keeping patients in follow-up and committed to treatment.

Bringing Art to Life: Measuring Engagement Through Art, Connection, and Dignity

The BATL program aims to improve the quality of life for community-dwelling people living with dementia (PWD) through art therapy, intergenerational contact, and life story preservation. This study utilized a modified ENGAGE measure (Hartmann et. al, 2017) to evaluate ethnographic transcripts recording activity and social engagement over time (N=100). A five-member analysis team independently coded the observation transcripts for engagement and qualitative themes. Results reveal average communication engagements (M=28.30, SD=13.36) significantly exceed the average art engagements (M=9.86, SD=5.56) over time t (98) = 20.85, p&lt;0.001). Emergent themes included reminiscence, intergenerational communication, and creating art. These mixed method results suggest the intergenerational contact and reminiscence portions of BATL were fundamental features in comparison with art-making. More studies are needed to determine if the BATL intervention 1) has greater comparative effectiveness than typical programs in adult service centers, and 2) is scalable nationally to enhance the quality of life in PWD.

“We Have Advised Sex Workers to Simply Choose Other Options”—The Response of Adult Service Websites to COVID-19

In-person sex work is one of the industries most directly affected by the COVID-19 pandemic. In order to connect with clients, most independent sex workers use adult service websites (ASWs), whose services range from simple advertising websites to platforms with both direct and indirect governance of workers. Although ASWs do not employ sex workers, their response to the pandemic has a large impact on sex workers’ financial and physical wellbeing. This effect is even stronger among migrant workers, who are less likely to qualify for, or be aware they qualify for, government support. This study reviews the response to COVID-19 of 45 of the leading ASWs in Britain, and triangulates the data with seven sex worker-led organisations. It shows a large variation in the responses of ASWs: the majority had no public response to the pandemic at all, a minority took intentional steps to support workers or donated to hardship funds for sex workers, and at least one ASW reduced their safety features during the pandemic. These findings illustrate that while most ASWs do not acknowledge the influence they have over the working practices of their service users and the shift of economic risk to them, some recognised the potential that their platforms have to support sex workers during crises.

Turner syndrome through the lens of a gynaecologist

Turner syndrome is a rare condition affecting 1 in 2500 female births and yet is the most common sex chromosome abnormality in women. Described as a cradle-to-grave condition, it requires life-long multidisciplinary management. Accelerated atresia of the primordial follicular pool leads to premature ovarian insufficiency, which is an almost inevitable feature of Turner syndrome, especially in 45XO karyotype. Many patients will have had their diagnosis made in childhood and require paediatric endocrinology management especially for induction of puberty. At the age of 18, patients may then be transitioned to an adult service. Continuation of multidisciplinary care for these women requires input from specialist services in menopause care, reproductive medicine and high-risk pregnancy, cardiology, endocrinology, bone health and psychosocial care. A gynaecologist may take on the mantle of lead clinician especially during the perceived reproductive years of a Turner syndrome patient’s life, hinging together management input from other disciplines. This review attempts to summarise an overview of the involvement of such a multidisciplinary team in the management of a single but complex condition, through the lens of a gynaecologist.