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Reflections on Coercion in the Treatment of Severe Anorexia Nervosa

Israel Journal of Psychiatry and Related Sciences, Vol. 43, No. 3, pp. 159-165, 2006

Sydney Law School Research Paper No. 08/11

18 Pages Posted: 3 Jan 2008  

Terry Carney

The University of Sydney Law School

Alison Wakefield

Royal Prince Alfred Hospital

David Tait

University of Canberra

Stephen Touyz

University of Sydney

Abstract

Abstract: Background: The high mortality of severe anorexia nervosa causes clinicians to consider any legal avenues for coercing acutely ill-patients to remain in treatment or re-feeding programs, such as mental health laws or adult guardianship laws. Method: Review of pattern of laws for coercing treatment in various jurisdictions and retrospective file analysis over 4.7 years for a specialist anorexia unit in the State of New South Wales, Australia, to isolate attributes associated with resort to two different avenues of legal coercion. Results: Coercion is most likely indicated for patients with more chronic histories (prior AN admissions), already known to the unit, where they present with other psychiatric illnesses and a low BMI index. Compared to voluntary admissions, coerced patients were significantly more likely to experience the refeeding syndrome (an indicator of being seriously medically compromised). They were more likely to be tube fed and placed on a locked unit. Limitations: sample size, limited variables and retrospective analysis method. Conclusions: The study suggests that, where available, clinicians will use legal coercion to help treat severe medical crisis situations, or manage behaviours such as vomiting, excessive exercise/sit-ups, or of absconding to no fixed abode when patients are very young.

Keywords: Anorexia Nervosa, Mental health, Coercion

JEL Classification: K10, K32, I18, I19

Suggested Citation

Carney, Terry and Wakefield, Alison and Tait, David and Touyz, Stephen, Reflections on Coercion in the Treatment of Severe Anorexia Nervosa. Israel Journal of Psychiatry and Related Sciences, Vol. 43, No. 3, pp. 159-165, 2006; Sydney Law School Research Paper No. 08/11. Available at SSRN: https://ssrn.com/abstract=1080110

Terry Carney (Contact Author)

The University of Sydney Law School ( email )

New Law Building, F10
The University of Sydney
Sydney, NSW 2006
Australia

Alison Wakefield

Royal Prince Alfred Hospital ( email )

Missenden Road
Camperdown NSW 2050
Australia

David Tait

University of Canberra ( email )

Law Faculty
Canberra, ACT 2601
Australia

Stephen Touyz

University of Sydney ( email )

University of Sydney
Sydney NSW 2006, NC
Australia

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