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Ignoring the alarms: How NHS eating disorder services are failing patients

Case summary - Miss E

Miss E was in her late twenties and had suffered from anorexia nervosa, with binge eating and vomiting, since adolescence. In early summer 2010 Miss E’s weight and body mass index dropped and she became depressed and withdrawn. She was admitted for a short time to both a medical and a psychiatric ward. During this time, Miss E’s mental capacity was assessed by a psychiatrist and she was considered able to make her own decisions about her medical care and treatment. This assessment was fundamentally flawed. Miss E lacked the capacity to make these decisions yet the psychiatrist and other staff failed to recognise this.

Nor did Miss E receive sufficient support given the major psychiatric symptoms she had, and there was a lack of knowledge and experience of eating disorders among staff supporting her at the hospital. She should have been referred to a specialist eating disorders unit as an urgent case.

Miss E was discharged home with a care plan that included checks by her GP, support from a home support service, a care coordinator and a clinical psychologist. Once back at home Miss E started to regularly make herself sick and cancelled her home support service. Her condition deteriorated and she died soon after from a heart attack.

Miss E’s discharge from hospital was poorly planned and her care plan was inadequate for her needs and not in accordance with guidance. Given her severe illness and suicidal thoughts, Miss E’s care plan should have included close supervision and frequent mental and physical assessments. None of this was done.

Her induced vomiting at home reduced her blood potassium to dangerously low levels that triggered the heart attack. In hospital, doctors would have regularly checked this and treated her. If Miss E had been in hospital, it is likely she would have survived.