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Head To Head

Should youth mental health become a specialty in its own right? Yes

BMJ 2009; 339 doi: (Published 26 August 2009) Cite this as: BMJ 2009;339:b3373

What about Eating Disorders?

The debate on the need for specialist youth mental health services is
one that continues to divide professional opinion.[1] As is often the
case, both authors have failed to include eating disorders in this heated
debate. Anorexia nervosa has the highest mortality of all psychiatric
conditions and its’ onset peaks in the mid-teens whilst that of bulimia
nervosa is 2 or 3 years later.[2] Both conditions, when left untreated,
often become chronic in nature and are accompanied by a range of comorbid
health problems.[3] Skilled early intervention has a profound beneficial
effect on the course of anorexia nervosa. A randomised controlled trial
showed that 90% of patients with anorexia nervosa given an effective
treatment (family therapy) within 3 years of illness onset have a good
outcome at 5 years whilst only 20% of cases have a good outcome when
treatment is given after 3 years of illness.[4]

Eating disorders are considered “bread and butter” to child and
adolescent services (CAMHS) whilst general adult services often feel that
they lack the specific skills to manage such cases.[2] Consequently, many
patients with eating disorders are managed within tertiary services once
they turn eighteen. The transitional period between services can be
problematic and is not always well-defined. Local protocols may dictate an
age-rather than needs-led care pathway that is not always in the best
interest of the patient. This uncertainty comes at a time when
intervention is most effective and continuity of care is essential for
good long-term outcomes.

Care pathways might introduce the “specific services........available
for those in the 16-9 gap” suggested in an intercollegiate report of the
Working Party of Adolescent Health.[5] Such an approach has been
successful in early-onset psychosis and is likely to suit young people
with non-psychotic but chronic mental health disorders, such as eating
disorders. Developing and focusing clinical expertise in this area would
help to “strengthen services where they are at their weakest”.


1. McGorry P, Birleson P. Should youth mental health become a
speciality in its own right? BMJ 2009; 339: b3371 (10 October)

2. Treasure J, Schmidt U, Huggo P. Mind the gap: service transition
and interface problems for patients with eating disorders. British Journal
of Psychiatry 2005; 187: 398-400.

3. Brambilla F, Monteleone P. Physical complications and
physiologociual aberrations in eating disorders: a review. Eating
disorders (pp.139-192) 2003. Chichester: Wiley and sons.

4. Eisler I, Dare C, Russell G.F., et al. Family and individual
therapy in anorexia nervosa. A 5-year follow-up. Archives of General
Psychiatry 1997, 54,1025-1030.

5. Intercollegiate Working Party for Mental Health (2003) Bridging
the Gaps: Healthcare for Adolescents. London: Royal College of Paediatrics
and Child Health.

Competing interests:
None declared

Competing interests: No competing interests

22 October 2009
William R Jones
ST4 in Psychiatry
John F. Morgan, Consultant Psychiatrist, Yorkshire Centre for Eating Disorders, Newsam Centre, Seacroft Hospital, York Road, Leeds LS14 6WB
Yorkshire Centre for Eating Disorders, Newsam Centre, Seacroft Hospital, York Road, Leeds LS14 6WB