Decision report 201202231

Summary

Ms C complained about the treatment her daughter (Miss A) had received from the Child and Adolescent Mental Health Service (CAMHS). She said that they had not responded soon enough when she and her daughter had expressed concerns about Miss A. Miss A experienced a significant deterioration in her eating behaviour, which coincided with a planned break from treatment, and a change in treatment staff. Ms C told us that she was concerned about her daughter's behaviour and weight loss, and while the staff did respond, by the time Miss A was referred to a specialist unit, she had to be hospitalised for re-feeding before she could receive treatment for her eating disorder. She felt that this significant deterioration in her daughter's health could have been avoided.

As part of our investigation, we sought independent advice from one of our medical advisers. Having taken this advice, we upheld Ms C's complaint on the basis that, while community-based approaches to eating disorders can be effective, they require a strong working relationship between family and staff. This should be in place before the situation becomes critical. Given the absence of such a relationship, the community-based approach was unlikely to be effective in Miss A's case. The absence of a risk assessment also meant that there was less scope for staff to correctly assess the situation when it became critical, and act accordingly. The family had to wait for over a month before Miss A was referred to a specialist unit, and during this time her weight loss continued and her condition deteriorated. We agreed that this could have been avoided if an eating disorder risk assessment had been in place.

Recommendations

We recommended that the board:

• develop a clear CAMHS protocol about the risk assessment of eating disorders;
• consider developing clear CAMHS guidelines on what situations merit priority and specialist referral; and
• provide information which will assure the Ombudsman that systems are in place within the CAMHS team to ensure that handover (including risk assessment) between health professionals is robust and documented to the standards required.