NEDA TOOLKIT for Parents
Feeding Against the Will of the Patient
C — Feeding against the will of the patient should be
an intervention of last resort in the care and
management of anorexia nervosa.
C — Feeding against the will of the patient is a highly
specialized procedure requiring expertise in the care
and management of those with severe eating
disorders and the physical complications associated
with it. This should only be done in the context of the
Mental Health Act 1983 or Children Act 1989.
C — Health care professionals without specialist
experience of eating disorders, or in situations of
uncertainty, should consider seeking advice from an
appropriate specialist when contemplating a
compulsory admission for a patient with anorexia
nervosa, regardless of the age of the patient.
C — Health care professionals managing patients with
anorexia nervosa, especially that of the binge purging
sub-type, should be aware of the increased risk of self-
harm and suicide, particularly at times of transition
between services or service settings.
C — When making the decision to feed against the will
of the patient, the legal basis for any such action must
be clear.
Additional Considerations for Children and
Adolescents Service Interventions for Anorexia Nervosa
C — Health care professionals should ensure that
children and adolescents with anorexia nervosa who
have reached a healthy weight have the increased
energy and necessary nutrients available in their diet
to support further growth and development.
This section considers those aspects of the service
system relevant to the treatment and management of
anorexia nervosa.
C — Most people with anorexia nervosa should be
treated on an outpatient basis.
C — Where inpatient management is required, this
should be provided within reasonable travelling
distance to enable the involvement of relatives and
carers in treatment, to maintain social and
occupational links, and to avoid difficulty in transition
between primary and secondary care services. This is
particularly important in the treatment of children and
adolescents. C — Inpatient treatment should be considered for
people with anorexia nervosa whose disorder is
associated with high or moderate physical risk.
C — People with anorexia nervosa requiring inpatient
treatment should be admitted to a setting that can
provide the skilled implementation of refeeding with
careful physical monitoring (particularly in the first
few days of refeeding), in combination with
psychosocial interventions.
C — Inpatient treatment or day patient treatment
should be considered for people with anorexia
nervosa whose disorder has not improved with
appropriate outpatient treatment, or for whom there
is a significant risk of suicide or severe self-harm.
C — In the nutritional management of children and
adolescents with anorexia nervosa, carers should be
included in any dietary education or meal planning.
C — Admission of children and adolescents with
anorexia nervosa should be to age-appropriate
facilities (with the potential for separate children and
adolescent services), which have the capacity to
provide appropriate educational and related activities.
C — When a young person with anorexia nervosa
refuses treatment that is deemed essential,
consideration should be given to the use of the Mental
Health Act 1983 or the right of those with parental
responsibility to override the young person’s refusal.
C — Relying indefinitely on parental consent to
treatment should be avoided. It is recommended that
the legal basis under which treatment is being carried
out should be recorded in the patient’s case notes, and
this is particularly important in the case of children
and adolescents.
C — For children and adolescents with anorexia
nervosa, where issues of consent to treatment are
highlighted, health care professionals should consider
seeking a second opinion from an eating disorders
specialist. Page | 39