Case Study: Anorexia

Joyce is a 47-year-old woman who has suffered with anorexia since she was 17 years old. She has been in and out of mental health services for treatment and care for allL of her adult life. Joyce openly tells you that she does not want to ‘recover’, she says that she is ‘anorexic’ and that she knows nothing else, so cannot re-define herself at this stage in her life. Her BMI is 15.6 and she is agreeable to eating no more than 500 calories a day, but insists in a ‘vegan’ diet as this conforms to her ‘beliefs’. Joyce has been an inpatient with a specialist eating disorder unit (SEDU) for 5 months now on Section 3 of the MHA  and her weight has barely increased at all. The nurses are beginning to feel frustrated at Joyce’s lack of weight gain. What are the issues here?

There are a number of issues that require consideration, and we would encourage you to look at the literature to support your perspectives, especially the MARSIPAN guidance and the new NICE guidance (2017) .

• Consider the treatment plan: Were SMART goals established?
• How can you maintain staff morale and prevent ‘burn-out’ which is common in such services?
• What would be the risks, if you decided to discharge Joyce?
• What would be the benefits of discharging Joyce?
• What community services would be available in your area to support her?
• Can you enforce a diet plan which is greater than the 500 calories which is considered acceptable by Joyce?