ISSUE 10
EATING DISORDERS SECTION
ROYAL COLLEGE OF PSYCHIATRISTS
December 2012
Inside this issue
1) Foreword from the editors
2) Foreword from the chair
3) AED news
4) Assessing Capacity in Eating disorders
5) EDSECT annual conference –two trainees’ perspectives
6) Poster winner
7) Other News and forthcoming events
8) List of Executive Members of EDSECT
1. Foreword from the Editors
Time has passed quickly again since our last newsletter and this time round we will
be focussing again on the Annual conference held in November 2012.
Congratulations and many thanks again to Frances Connan for another amazing
conference where we were able to listen to many renowned speakers and also to
catch up with friends and colleagues.
It was great to hear a lot of positive feedback about the conference and especially
from Jane Morris who told us about two very inspired and enthralled students from
Aberdeen who are thinking about psychiatry electives!
We thank AED president Dasha Nichols who has agreed to provide news from AED
as a standing item in our newsletter.
Jacinta Tan, senior research fellow and an empirical medical ethicist has written for
us a great article on assessing decision-making capacity in patients with eating
disorders. Can we remind you again that we would welcome any issues that
members would like to be included in the newsletter.
The bursary winners of a place at this year’s annual academic meeting, were Peter
Sellars, E Barrett, J Theivendran, K Jawahar and Jessica Wright. Peter and
Gemma have both written articles for this newsletter which are well worth a read.
Dr Golnar Aref-Adib’s poster presentation won this year and makes interesting
comments in the present climate of a wish for early discharges by various
commissioning bodies.
Dr Irene Yi
Editor
Irene.Yi@sabp.nhs.uk
Dr Rebecca Cashmore
Co-Editor
Rebecca.cashmore@leicspart.nhs.uk
2- Foreword from the Chair
Dear Colleagues,
We are pleased to be bringing you another issue of the Section’s newsletter, with
wide ranging contributions on many subjects that should be interesting and
enlightening.
Trainees continue to be actively involved in the Section, with high quality and
competitive submissions for the Section Poster Prize. This prize was established to
encourage interest in Eating Disorders psychiatry and research in the specialism,
and we are fortunate to attract high calibre submissions, as well as an increasing
number of Bursaries to attend the Section Annual Meeting.
Our Annual Conference was held on 2 November 2012, at the Cavendish
Conference Centre, London. Thanks are especially due to Frances Connan for her
indefatigable enthusiasm. The conference was acclaimed by attendees, and covering
a wide-range of clinically relevant topics, in relation to medical and treatment
issues.
Our Executive Committee has welcomed a number of new members and bade
farewell to some old friends. We maintain our primary focus on ensuring quality of
treatments around the UK, engaging proactively with new processes of
commissioning and carving out our special expertise as a subspecialty of
psychiatry.
The issue of ensuring high quality services remains a key concern, and our UK-wide
quality assurance network of eating disorders services is germinating nicely.
Finally, we look forward to 2013 with all its promises and pitfalls. As the Health and
Social Care Act puts competition between services at its heart, we are committed to
putting quality and collaboration at the centre of our own philosophy.
With kind regards
John
Dr John Morgan
Chair EDSECT
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3. Update from the Academy for Eating Disorders
In the last EDSECT newsletter I told you a bit about the AED, who we are, and
debunked a few myths. If you missed it, here is the link to the last newsletter (see
section 7). [link to
http://www.rcpsych.ac.uk/members/sections/eatingdisorders.aspx ]
This time I thought I’d tell you a bit about some things the AED have been up to
recently that might be of interest to EDSECT.
Firstly, the AED has recently published the long awaited Residential and Inpatient
standards https://www.aedweb.org/AED_Inpatient_Standards.htm . The purpose
of the guidelines is to promote high quality residential and inpatient treatment for
eating disorders. Specifically they are intended to (a) safeguard patients and
families who seek eating disorder residential and inpatient treatment; (b) review and
improve the quality of care offered by residential and inpatient treatment programs;
and (c) provide a quality of care benchmark for third party payers in the
development of comprehensive models of care and its reimbursement, where
applicable. Like the QED standards, the recommendations are intended for use in
clinical governance, quality assurance and/or the development of key performance
indicators. In the USA they will also be used as a guide for credentialing of
treatment programs.
The AED does not see its role as ‘accrediting’ organisations or individuals, but
rather using our expertise to collate and distil information to produce best practice
guidance based on evidence, where available. The initial steps for this venture
preceded QED, and indeed may have influenced it, since both Janet Treasure and
Tony Jaffa were part of the process. The complexities and political sensitivities of
US health care has made progress towards standards that are likely to have a
acceptability in the US, never mind applicable globally, a slow and challenging task.
Nonetheless, we are delighted that the basic elements of good care for people with
eating disorders have been laid out succinctly and specifically in a way that will be
of use to those seeking treatment as well as those delivering it. We are now in
4
discussions about developing standards for individual eating disorders
practitioners.
There is only a limited amount that can be achieved in a year as President, so my
aim is simply to handover, in May, to our incoming President, the great Pam Keel,
an organisation strong and healthy enough for the next stage of its development, as
the AED comes into its 21st year. The main thrust of my work with the AED this
year has been to overhaul our strategic plan i.e. its vision, mission, goals and
objectives. Unlike EDSECT, we rely on donors to support the extensive scholarship
programme for clinicians and researchers, whilst also meeting the needs of
members in many different countries and health care settings. It’s quite a big task!
Thankfully I have had the support of Karine Berthou, CEO and Founder of the
SUCCEED foundation www.succeedfoundation.org, and business woman supreme,
and of the AED advisory board, which includes the fabulous Susan Ringwood, CEO
of b-eat www.b-eat.co.uk .
Finally, we are in the throes of making plans for next year’s International
Conference on Eating Disorders (ICED) in Montreal. If you haven’t been, Montreal
really is the best amalgam of North American and European culture. The conference
promises to be great too. Our own Nadia Micali, together with Bryn Austin from
Harvard, has been jointly responsible for putting the conference programme
together and overseeing the scientific committee. Caroline Meyer has also been part
of the programme planning team, all accountable to Glenn Waller as Director for
Annual Meetings. So quite a strong UK presence! The theme for the 2013 ICED is
“Crossing Disciplinary Boundaries in Eating Disorders.” There will be sessions on
BED and Obesity, Biology and Medical Complications, Body Image and Prevention,
Children and Adolescents, Comorbidity, Course and Consequences of Eating
Disorders, Diagnosis, Classification and Measurement, Epidemiology, Gender,
Ethnicity, and Culture, Personality and Cognition, Risk Factors and Eating
Disorders in Underserved Populations, Risk Factors for Eating Disorders and
Treatment of Eating Disorders. There will also be special interest sessions, a session
dedicated to research-practice integration, and welcome, closing and award
ceremonies. If you haven’t been to an AED conference, I would be delighted if you
would join me there.
Until next time, wishing you all a very Merry Christmas and Happy New Year.
Dasha Nicholls
5
President, AED
Great Ormond Street Eating Disorders Team
6
4. Assessing decision-making capacity in eating disorders
Jacinta O A Tan, Senior Research Fellow
Address:
The College of Health and Human Sciences, Swansea University, SA2 8PP, United
Kingdom
Correspondence to: j.o.a.tan@swansea.ac.uk
In two recent legal cases in Wales and England, judges have reached different
conclusions as to whether compulsory treatment was in the best interests of
patients suffering from severe and life threatening eating disorders.(1, 2)i Both
judges, however, found that these patients lacked capacity to make decisions about
their treatment. In the case of Re E, Justice Jackson found that although E could
understand the information and communicate a decision, the anorexia nervosa
made her unable to use and weigh the information and she therefore lacked
capacity. These rulings make it clear that capacity in eating disorders can be a
problematic issue.
As mental disorders, eating disorders falls under both the scope of both mental
health and mental capacity legislation in England, Scotland and Wales. On the one
hand the Mental Health Act 2007 could be used to deliver treatment of a mental
disorder (but not of other unrelated medical conditions) without a patient’s consent
if there is a significant risk posed to the individual (or others), without reference to
capacity.(3) The Mental Health Act Commission has clarified that re-feeding
constitutes treatment of an eating disorder under the meaning of the Mental Health
Act.(4) On the other hand, the Mental Capacity Act 2005 and Adults with Incapacity
(Scotland) Act 2000 allow decision-making by others regarding treatment and other
aspects of life in the best interests of a person, if that person lacks capacity.(5, 6)
Where there is no mental capacity legislation, for example in Northern Ireland, case
law suggests patients who lack capacity should similarly be treated in their best
interests.
With the availability of mental health legislation, why would we need to assess
capacity? There are (at least) three scenarios where this might be useful:
1. Where the disorder is considered by clinicians to be untreatable and they
need to decide whether to accept patient refusal of treatment, nutrition or
life-sustaining measures;
2. Where the disorder may be treatable but there is doubt in the clinical team
about whether formal compulsory treatment is appropriate, so knowing
capacity status can guide the team as to how much weight they should give
to patient decisions which may not be in their own best interests;
3. Contentious cases, for instance prolonged use of mental health legislation,
where the assessment of capacity may help inform clinical and tribunal
decisions.
The definition of incapacity varies between different legal jurisdictions (see box for
current definitions applying to the United Kingdom). Grisso and Appelbaum in the
USA developed the MacCAT-T instrument of competence which conceptualises
capacity as: Understanding, Retention, Appreciation, and Reasoning (comparative
and consequential).(7) Importantly, the mental capacity laws applying in England,
Wales and Scotland require that incapacity arises from disturbances of mind, which
includes mental disorder. Studies have shown that there are high rates of
incapacity amongst inpatients in acute general medical and psychiatric wards.(8, 9)
Worse, however, physicians often fail to detect patients’ incapacity.(8)
In some cases of mental disorder, it would be evident that a person lacks capacity,
for example if a patient is extremely thought disordered from schizophrenia or
severely cognitively impaired from dementia. In eating disorders, however, sufferers
typically have the ability to understand and retain information, and indeed many
possess an impressive knowledge of their illness and its risks. There are, however,
other ways in which eating disorders may affect the ways in which, or the reasons
for which, people with eating disorders might make decisions about whether or not
to accept treatment. Any assessment of capacity therefore needs to be both
thorough and nuanced to pick up more subtle but significant difficulties in
decision-making. The application of the Mental Capacity Act in the two law cases
suggests that the main difficulties are generally categorised under the broad
criterion ‘ability to use and weigh information’. This criterion, however, is poorly
defined and gives little guidance to the clinician. A suggested format for assessment
which should help clinicians to perform a full assessment of factors which may
affect capacity is given below.
8
Format for the assessment of capacity in eating disorders
1. Assess ability to understand and retain information
Checking understanding and retention is fairly straightforward – disclosure can be
followed by a request for the patient to repeat the information back in his or her
own words. The MacCAT-T competence instrument provides a structured and
systematic framework for doing this. (7)
2. Assess ability to use information
This can be assessed in the course of the discussion and by asking the patient for
his/her reasons for the decision - it should become evident whether the patient is
able to use the information provided.
3. Assess appreciation of information and facts of the decision
Appreciation, not seen in UK legislation but found in Grisso and Appelbaum’s
definition of competence, is the ability to apply the information to oneself.(7) This
can be a problem in eating disorders, for example, a patient may say, “I understand
that’s the definition of an eating disorder, I understand I have those features, and I
understand eating disorders need treatment; but I do NOT have an eating disorder
and therefore I do not need treatment”. This clearly would affect capacity to make
decisions about treatment for an eating disorder.
4. Assess presence of compulsion
Look for compulsions (or obsessions) that may prevent the patient from acting on
the basis of his/her understanding or even desires. The Code of Practice of the
Mental Capacity Act gives an example that patients with anorexia nervosa may be
unable to ‘use and weigh’ treatment information as part of the decision-making
process: “For example, a person with the eating disorder anorexia nervosa may
understand information about the consequences of not eating. But their
compulsion not to eat might be too strong for them to ignore.”(10)
5. Assess for changes in values due to the eating disorder
It is part of the core criteria of anorexia nervosa that a person should either have a
fear of fatness, or an overvaluing or pursuit of thinness.(11) This dread of fatness
and overvaluing of thinness, found in many eating disorders, means that being thin
or losing weight becomes disproportionately highly valued by sufferers, in some
cases this is even valued above life itself. This disproportionate value can drive
9
some patients to decide, even after they have weighed up the options, not to have
treatment because they would rather die than gain weight.(12)
6. Assess for changes in identity due to the disorder
One of the characteristics of eating disorders is that they can be egosyntonic
disorders, that is, experienced as part of the self and also consistent with one’s own
values.(13) Further, many people with eating disorders become ill as adolescents,
and may as adults have little or no sense of who they would be without the
disorder. This intertwining of the disorder with the sense of self can make it difficult
to decide to have treatment in order to recover from it; for example, patients may be
either unable to envisage a self without eating disorders.(12)
7. Assess for depressive features, loss of hope and affective elements
Eating disorders have clear effects on emotion and mood; there is a high rate of
comorbidity of depression.(14) It is important to assess for depressive features and
particularly for suicidality, more covert wishes for death (for example, wanting to
die thin) and inability to envisage or hope for recovery, all of which would affect how
options are weighed. Charland and colleagues further argue that beyond comorbid
depressive disorder, anorexia nervosa itself may have clear affective components,
fitting Ribot’s conception of a ‘passion’ in its very nature.(15) These components
include having a fixed focus and motivational force and attachment; these may have
an impact on decision-making.
Conclusion
There are several ways in which eating disorders can affect decision-making. This
does not mean, however, that all patients who have eating disorders lack capacity.
It also does not mean that all patients who have eating disorders should be
compelled to have treatment, though it should be borne in mind that patients
themselves favour compulsory treatment to save life.(16, 17) Capacity must always
be assessed at the time for the decision at hand. The assessment of capacity
requires a careful and systematic approach, but as the MacCAT-T instrument
acknowledges, even with formal instruments, in the end the judgement of the
presence or absence of capacity is a clinical, global judgement.(7)
10
Definition of incapacity in England and Wales:
The inability –
(a) to understand the information relevant to the decision,
(b) to retain that information,
(c) to use or weigh that information as part of the process of making the
decision, or
(d) to communicate his decision (whether by talking, using sign language or any
other means)” (5)
Definition of incapacity in Scotland:
A person who is not capable of –
(a) acting; or
(b) making decisions; or
(c) communicating decisions; or
(d) understanding decisions; or
(e) retaining the memory of decisions.(6)
Definition of incapacity in Northern Ireland:
Common-law test applies. This test of capacity is as follows:
(a) Does the patient comprehend and retain treatment information?
(b) Does the patient believe that information?
(c) Does the patient weigh that information, balancing risks and needs, to arrive
at a choice? (18)
Jacinta Tan Senior Research Fellow at Swansea University
Honorary Consultant Psychiatrist Eating Disorders Team at the Abertawe Bro
Morgannwg University Health Board, Wales.
References:
1.
A Local Authority v E [2012] EWHC 1639 (COP).
2.
Gordon C. Force-feeding 'not in best interests' for 3 stone anorexic woman.
The Independent [serial on the Internet]. 2012: Available from:
http://www.independent.co.uk/life-style/health-and-families/healthnews/forcefeeding-not-in-best-interests-for-3-stone-anorexic-woman8079158.html.
3.
The Mental Health Act 2007. Available from:
http://www.legislation.gov.uk/ukpga/2007/12/pdfs/ukpga_20070012_en.pdf.
11
4.
Mental Health Act Commission. Guidance Note 3: Guidance on the treatment
of anorexia nervosa under the Mental Health Act 1983. London: HMSO; 1997.
5.
The Mental Capacity Act 2005: Available from:
http://www.dca.gov.uk/menincap/legis.htm.
6.
Adults with Incapacity (Scotland) Act 2000: Available from:
http://www.legislation.gov.uk/asp/2000/4/pdfs/asp_20000004_en.pdf.
7.
Grisso T, Appelbaum P-S. MacArthur Competence Assessment Tool for
Treatment (MacCAT-T): Sarasota FL US: Professional Resource Press/Professional
Resource Exchange Inc. vi 35 pp.; 1998.
8.
Raymont V, Bingley W, Buchanan A, David AS, Hayward P, Wessely S, et al.
Prevalence of mental incapacity in medical inpatients and associated risk factors:
cross-sectional study. Lancet2004;364:1421-27.
9.
Owen G, Richardson G, David AS, Szmukler G, Hayward P, Hotopf M. Mental
capacity to make decisions on treatment in people admitted to psychiatric hospitals:
cross sectional study. British Medical Journal2008;337(Jun30):4.
10.
Department of Constitutional Affairs. Chapter 4: How does the Act define a
person’s capacity to make a decision and how should capacity be assessed? Mental
Capacity Act 2005 Code of Practice: TSO; 2007. p. 40-63.
11.
World Health Organisation. F50.0: Anorexia nervosa. ICD-10 Classification
of Mental and Behavioural Disorders. Geneva: World Health Organisation; 1994.
12.
Tan JOA, Hope T, Stewart A, Fitzpatrick R. Competence to make treatment
decisions in anorexia nervosa: thinking processes and values. Philosophy,
Psychology and Psychiatry2006;13(4):267-82.
13.
Serpell L, Treasure J, Teasdale J, Sullivan V. Anorexia nervosa: friend or foe?
Int J Eat Disord1999 Mar;25(2):177-86.
14.
Braun DL, Sunday SR, Halmi KA. Psychiatric comorbidity in patients with
eating disorders. Psychol Med1994 Nov;24(4):859-67.
15.
Charland LC, Hope T, Stewart A, Tan J. Anorexia Nervosa as a Passion.
Philosophy Psychiatry & PsychologyIn press.
16.
Tan JO, Stewart A, Fitzpatrick R, Hope T. Attitudes of patients with anorexia
nervosa to compulsory treatment and coercion. Int J Law Psychiatry2010 JanFeb;33(1):13-9.
17.
Watson TL, Bowers WA, Andersen AE. Involuntary treatment of eating
disorders. Am J Psychiatry2000 Nov;157(11):1806-10.
18.
Re C. (Adult: Refusal of Treatment), In re [1994] 1 W.L.R. 290; [1994] 1 All
E.R. 819.
At the time of writing, the legal ruling is not yet available in the public domain and
the only information available is from newspaper reports.
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5. EDSECT Annual Conference – A Trainee perspective
The EDSECT National Conference – Perspective from a Medical Student
None of the Royal Colleges seem to have put as much genuine effort into trying to
encourage and enable students to pursue their career pathways as the Royal
College of Psychiatrists. I first became aware of the conference via the student
associate newsletter. As a local co-ordinator for the Student Run Self Help (SRSH)
group for young people with eating disorders, I was immediately drawn to the
possibility of such a valuable opportunity to further my learning on the subject and
for local networking. I was very grateful for the prompt response from the Royal
College and for the bursary that made the possibility of attending a reality.
The conference itself was a truly pleasurable learning experience. The cross
professional involvement, included pure scientists and the Rheumatology team, as
well as Psychiatrists. This painted a multidimensional image of the service and the
professionals closely working together to look after the patients in their care. As an
ex-neuroscientist I may be slightly biased in mentioning the presentation by
Professor Kringelbach on pleasure centres involved in food intake and the
implications of reward pathways on eating disorders. I found this to be of particular
interest personally as the neurological pathways described are shared by many
other conditions. Whilst this research may still be in its infancy, it may help to
direct more targeted management for these conditions in the future.
The general atmosphere of the conference was very friendly and I was struck by
how approachable the other delegates were. When it came to patient management I
learnt as much by talking to the attending consultants as I did from the insightful
post presentation discussions. I thoroughly enjoyed the manner in which each
consultant, including the speakers shared their personal experiences for patient
management. I believe this very revealing of the heterogeneity of the subject and
each individual patient experience. I also believe this is perhaps the most important
point which I will take away with me from the conference.
I would like to thank the Royal College of Psychiatrists for this enriching experience.
Peter Sellars
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The EDSECT National Conference – Perspective from a Psychiatry CT1 trainee
I was fortunate to be awarded a bursary to attend the Eating Disorder Annual
Section meeting, held at the Cavendish Conference Centre on 2nd November 2012.
As a CT1 in psychiatry, with my only prior experience in the field being a few weeks
in an inpatient unit during my elective, I was a little unnerved that the content
would be heavily focused on the minutiae of eating disorders and would, therefore,
go over my head.
To my delight, I found the whole experience thoroughly enjoyable. The lecture hall
was packed, the food was good and the conference centre staff were very helpful.
The programme was varied and interesting, with medically orientated lectures on
bone health and fertility to psychology based ideas such as CBT as used in irritable
bowel syndrome. It was evident how these could link in with management of
patients with eating disorders, and spawned much discussion around the topics
after the lectures.
Two highlights were the presentation on the pleasure of food intake by Professor
Kringelbach, and the results of a study on Multi Family Therapy by Professor Eisler,
the proposal of which had been presented at a previous Eating Disorder Annual
section meeting.
The conference has positively contributed to my peaked interest in eating disorders,
and I feel inspired to pursue it further. As there are few training posts in the
specialty, the conference provides an invaluable opportunity for trainees to meet
those established in the field and start the cogs turning for developing a clinical or
research interest in eating disorders.
Jemma Theivendran
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5. EDSECT – Poster Winner
Early Discharge at the Expense of Readmission:
A Six-year Review of Admissions in an Eating Disorder Unit
Dr Golnar Aref-Adib CT3 Psychiatry BMedSci MBBS MRCPsych
Victoria Stone 4th Year Medical Student BSc (Hons)
Sarah Lawrence 5th Year Medical Student BSc (Hons)
Dr Panagiotis Kyrtatos FY2 Doctor BMedSci MBBS PhD
Emma Friddin Assistant Psychologist BSc
Dr Eric Johnson-Sabine Consultant Psychiatrist
MBBS, MRCGP, ,FRCPsych
Background
Whilst working as core psychiatry trainee on Phoenix Eating
Disorder Unit the first three patients I admitted had a BMI
ranging from 9 to 10. I was alarmed and surprised at the
severity of the cases and the team commented that
anecdotally year upon year admission and discharge BMI
was dropping. There was a general feeling that this could be
associated with stricter commissioning and leading to higher
readmission rate. The new constraints in commissioning became evident as I
observed how funding had to be sought prior to each admission with estimated date
of discharge specified on entry.
Under the supervision of the consultant I worked with a team of medical students
and a psychology trainee to determine whether there was a trend for discharge from
hospital to occur at a lower BMI over the course of the last 6 years and whether this
was leading to a higher readmission rate.
About the Phoenix Wing
The Phoenix Wing, St Ann’s Hospital is a tertiary referral centre.
It is
commissioned to serve a population of 5 ½ million in North Central, North East
London & home counties. There are approximately 1000 referrals per year. .
The unit provides comprehensive treatment for all types of eating disorders that
includes inpatient treatment (Phoenix Wing,15 beds), a residential stepped down
facility (Acacia House 5 beds) and a day service (Russell Unit, 8 places).
Aim
To determine whether new constraints in commissioning were
associated with:




Lower admission BMI
Lower discharge BMI
Increase rate of readmission
Shorter admissions
Method
The analysis comprised of a retrospective case note review of all inpatient
admissions from 2006 to 2011 to The Phoenix Wing Eating Disorder Unit. Data
regarding primary diagnosis, admission and discharge BMI, length of stay, mode of
discharge, MHA section status, and transfer to Acacia House were obtained from
the hospital database (RiO) and checked against the discharge summaries
completed by ward doctors. The data were all anonymised and each patient was
assigned a number, to cross reference in the event of readmission.The data was
entered in Excel and analysed using GraphPad Prism.
Results:
There have been 278 admissions since January 2006, with 240 of these having a
primary diagnosis of anorexia nervosa, 17 with severe bulimia nervosa and 21 with
atypical eating disorders. Mean age at admission was 30 years (median 27.5), with
95% of admissions being female. The average number of patients on MHA section
each year was 7 (range 4-9).
16
The average length of stay was 132 days and there was no significant variation over
the period from 2006 to 2011.
Admission and Discharge BMI over the last 6 years
For patients with anorexia, for the cohort
as a whole, mean BMI upon discharge
decreased steadily between 2006 and 2011
(p=0.05).
Mean
BMI
on
admission
decreased but was not significant (p=0.32).
Repeat admissions-Admission and Discharge BMI.
Mean admission and discharge BMI for
individual patients also decreased with
subsequent readmissions (admission
BMI p=0.03, exit BMI p=0.01).
% Readmissions within 12 months over the last 6 years.
From 2006 to 2011 there was a rise in
both the absolute and relative number of
readmissions of these patients.
% Increase in BMI for those who attended
Acacia step down.
17
The percentage change in BMI was higher for
those with an extended admission that
included the Acacia, step down facility (p=0.03).
Conclusion
These data confirm that patients are being discharged at lower BMIs with a poorer
psychiatric outcome and higher readmission rate.
Admission and discharge at lower BMI is likely to be associated with more
psychiatric morbidity in the community and reduced likelihood of making a social
recovery. As length of stay was unchanged, there was no cost saving and the
increased rates of readmission suggest that over time there will actually be a cost
increase.
Commissioners are encouraged to review reasons behind early discharge and to
support admission at a higher BMI. This is an important public health message,
which could lead to potential savings in the long term.
A culture of stricter commissioning is associated with:




Lower admission BMI
Lower discharge BMI
Increase rate of readmission
Shorter admissions
6- Other News

Work on mapping of ED Service across the country is still continuing
with much work from Jessica Morgan and Agnes Ayton.

Paul Robinson’s training programme for the MARSIPAN is also taking
place
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8. EXECUTIVE MEMBERS OF EDSECT
Member
Year of joining
Position
Dr Agnes Ayton
2012 (C)
Co-opted Member
Dr John Morgan
2011 (E)
Chair
Dr Jane Shapleske
2007 (E)
Financial Officer
Dr Carol Wilson
2012 (A)
Psychiatric Training Committee Rep
Dr Rebecca Cashmore
2011 (E)
Elected Member
Dr Frances Connan
2007 (E)
Elected Member
Dr Philip Crockett
2011 (E)
Elected Member
Dr Christopher Freeman 2011 (E)
Elected Member
Dr Philippa Hugo
2011 (E)
Vice Chair
Ms Veronica Kamerling
2011 (C)
Co-opted Member
Dr Nikola Kern
2011 (E)
Academic Secretary
Dr Adrienne Key
2007 (E)
Elected Member
Dr Jessica Morgan
2011 (E)
Elected Member
Dr Elizabeth Morris
2011 (E)
Elected Member
Dr Sandeep Ranote
2011 (C)
Co-opted Member
Dr Lorna Richards
2007 (E)
Elected Member
Ms Susan Ringwood
2008 (C)
Co-opted Member
Dr Paul Robinson
2007 (E)
Elected Member
Dr Christine Vize
2011 (E)
Elected Member
Dr Irene Yi
2011 (C)
Co-opted Member
20