Anorexics Given New Rights Under Mental Health Laws

Teenage anorexics will win greater rights to refuse treatment for their eating disorders under controversial new mental health laws to be debated by MPs this week.

Parents have until now been able to override automatically a child’s wish not to be hospitalised for starving themselves, ensuring that they get treatment even if they do not want it. Sufferers are typically very resistant to doctors’ attempts to make them put on weight, because a distorted body image, which makes them believe they are fat when they are actually painfully thin, is the main aspect to the illness.

But government plans to give extra safeguards to 16- and 17-year-olds deemed capable of making decisions would shift the balance of power back towards the sufferers. While anorexics who became so thin that their condition was life-threatening could still be ‘sectioned’ under mental health law for their own safety, they would have the right to challenge their detention at a mental health tribunal, and, in some circumstances, to a second opinion.

The moves come at the height of the debate over whether the ‘size zero’ culture of glamorising extreme thinness has increased eating disorders among British girls. Cases such as that of the Brazilian model Ana Carolina Reston – who died aged 21 last year from an infection exacerbated by her anorexia, characterised by a diet of apples and tomatoes – highlighted the consequences of the trend.

The changes to the law were agreed by ministers as peers debated the Mental Health Bill, which comes before the House of Commons tomorrow. It includes controversial powers of compulsory treatment for psychiatric patients in the community, such as requiring schizophrenics to take their drugs when released; and to lock up patients with personality disorders, who could not previously be detained because their condition was seen as untreatable.

Susan Ringwood, chief executive of the eating disorders charity Beat, said many parents were very concerned about being able to get children treated. ‘Families obviously get desperately worried about vulnerable young people becoming very seriously ill, and yet are extremely reluctant to acknowledge that they are ill. From our experience, clinicians are extremely reluctant to take formal sectioning powers, because by itself it isn’t going to make you better,’ she told The Observer.

She said anorexia was also unusual among mental disorders in the severity of its physical consequences, such as organ failure. ‘In a young person with a serious eating disorder the physical consequences lead to greater medical risk earlier, and it would be for these medical risks that formal treatment is sought,’ she added.

Kathryn Pugh, of the mental health charity Young Minds, said the change could even help parents by taking difficult decisions about hospitalisation out of their hands: ‘This lays down a right in law for 16- and 17-year-olds not to have their refusals overriden.

‘Parents who have a mentally ill child have the most difficult job I can imagine. But in some respects this might help some parents. To be told “Your child doesn’t want this, but you can consent for them” can lead to an irretrievable breakdown in the relationship with the child.’

The bill has proved highly controversial because of separate measures to increase compulsory treatment for psychiatric patients who are released into the community.

Six major amendments to the mental health bill were passed in the Lords, including new criteria restricting the use of compulsory community treatment orders and the introduction of a ‘treatability test’ ensuring only those with a condition that could actually benefit from psychiatric treatment would be detained.

But the government will seek to overturn all six amendments in the Commons. The health minister Rosie Winterton said: ‘The reason we disagree so strongly with the Lords amendments is that they would effectively deny treatment to very vulnerable people who desperately need it.’

Among the bill’s critics is the eminent psychiatrist Professor Sheila Hollins, the mother of Abigail Witchalls, the young woman left paralysed after being stabbed by a psychotic stranger. Hollins has said the legislation offers a false sense of security and could send patients ‘underground’.

The Facts

Anorexia nervosa is a potentially life-threatening illness, and should be treated as soon as possible. It usually starts in the teenage years and is characterised by a body weight 15 per cent or more below that expected for a person’s height.

The illness was first detected by the medical profession in 1860 but the cause remains unknown, although both biological and social environment factors play a part. The disease is mainly encountered in the western world and is most common among women in certain professions, such as models and ballet dancers. Famous sufferers include Jane Fonda, Lindsay Lohan and Desperate Housewives star Felicity Huffman.

If the weight loss becomes serious (more than 20 to 25 per cent less than total normal body weight) admission to hospital may be required. Treatments used include individual therapy, family therapy and drug therapy using antidepressants. Long spells without adequate nutrition can cause osteoporosis and damage to the heart, liver, kidneys and brain.