Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision

Abstract

In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the UK. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before gaining an appreciation for what they need from services to help them feel heard going forward. Findings suggest current methods of service delivery result in delayed and inappropriate supports, and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working, and promote "revolving door" experiences.

Risk Factors for Revolving Door in Children and Adolescents with Psychiatric Disorders

“…Moreover, we found a moderate positive correlation between the suicidal ideation severity scores (C-SSRS) and the number of readmissions of RD patients confirms previous findings [21,22,26], showing that RD adolescents were at greater risk for suicide than non-RD patients. The chronic nature of suicide risk [28], as well as the limited efficacy of interventions to prevent severe suicidal ideation and suicide attempts [49,50], could explain our and existing results in which severity of suicidal ideation has been related to rehospitalization [22,29,51].…”

“…Having a greater functional impairment (C-GAS), suicidal risk (C-SSRS), and DP increased the odds of rehospitalizations (see Table 4). Moreover, in this logistic model, age, gender, and psychiatric diagnosis were not found to be significant contributors to RD but were considered for the adjusted model [9,16,22,24]. Even though the model was adjusted, no confounding effect was found between the predictive variables and age, gender, and psychiatric diagnosis.…”

“…Having non-suicidal self-injurious and being adopted increased the odds of rehospitalizations (see Table 3). It should be noted that age, gender, and psychiatric diagnosis were not significant contributors to RD, but were considered for the adjusted model because they may have affected the predictive variables [9,16,22,24].…”

“…Among the risk factors for rehospitalizations, clinical conditions such as suicidal ideation, self-injurious behaviours, and suicide attempts have the highest prevalence [9,21,22]. Indeed, adolescents with repeated rehospitalizations are twice likely to have suicide attempts [23,24].…”

The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia

“…Prior to the reform in this large jurisdiction of Australia, with no formal protocols for handling people with EDs in the hospital system, people with even severe illness reported being unable to gain access to hospital or repeated presentations to emergency before treatment was received [ 17 ]. As well as causing distress and anxiety for people with the illness and their carers, revolving door hospital encounters are very costly [ 18 ]. In hospital wards for those that did get admitted, clinical variability was the rule rather than the exception.…”