First-line in-patient psychiatric treatment does not provide advantages over out-patient management. Out-patient treatment failures do very poorly on transfer to in-patient facilities.

On the basis of cost-effectiveness, these results support the provision of specialist out-patient services for adolescents with anorexia nervosa.

NRR number (National Research Register) N0484056615; Current Controlled Trials ISRCTN39345394.

Much recent attention has focused on the fitness to practise of health professionals. Patients expect their care to be provided by therapeutic staff who can give support and guidance without unhelpful subjective influence. On the other hand, those recovered from health problems expect their employment prospects to be free of discrimination. Eating disorder services increasingly encourage patient and public involvement in service design and monitoring but reservations are sometimes expressed about employing staff who have themselves suffered with an eating disorder. This survey canvassed the views of patients, carers and professionals on the suitability of employing people with a history of an eating disorder as therapists in the same field. With some reservations (mainly from professionals), there was a widespread belief that those who had recovered would have therapeutic advantages as a result of their experience. Therapists with a current eating disorder, however, were thought to lack objectivity and to be vulnerable. Current UK policies on employment appear unnecessarily discriminatory and stigmatizing.

No abstract