Best practice in managing service transitions

There are a number of reasons why people with a diagnosis of an eating disorder may transition between services, for example, moving between child and adolescent services (CAMHS) to adult services due to age, a change in location due to reasons such as moving house or going to/leaving university, moving between inpatient and outpatient services, and moving between different types of specialist services. These transitions are often a vulnerable time for people affected by eating disorders, and can result in the person experiencing a lapse or relapse, and difficulties in accessing treatment. The devastating consequences of this were evident in the Ombudsman report into the death of Averil Hart, who tragically died from a heart attack triggered by starvation from anorexia nervosa, at the age of 19 years old. The Ombudsman report stated that “inadequate coordination and planning... when (Averil) was leaving home to go to university” was one avoidable failing that contributed to her death. This devastating loss highlights the importance of managing transitions; best practice guidance around this process have been widely reported in relation to both eating disorders specifically, and mental health services more generally.

This paper proposes a series of best practice standards for adoption by all healthcare providers offering eating disorder services. These build upon the Royal College of Psychiatrists’ (RCPsych) guidance for managing transitions. The paper will also share the experiences of both those affected by eating disorders and those supporting someone who have undergone a transition between services in the last five years, and will review these transitions against RCPsych’s recommendations.

Results demonstrate that best practice is often not followed. When asked to describe positive experiences about the transition, the most cited theme from both those affected by an eating disorder and those supporting someone was “nothing”, with people commonly being left with no information or support at a very difficult time. Although some people were able to describe positive experiences, findings emphasise that more needs to be done to ensure people are supported throughout this vulnerable period to avoid potentially devastating consequences.

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