Avoiding deaths in hospital from anorexia nervosa: the MARSIPAN project
About this resource
The MARSIPAN (Management of Really SIck Patients with Anorexia Nervosa) project was established in response to reports of patients admitted to medical wards and proving refractory to treatment, sometimes dying on the ward. Psychiatrists, physicians and other clinicians in nutrition and eating disorders were brought together to discuss key issues in the assessment and management of such patients. The resulting guidance report, which applies to adult patients over 18, addresses: assessment of risk, where to treat the patient, specialist support for medical teams, key elements of treatment, namely (a) safe refeeding to avoid refeeding syndrome and underfeeding syndrome, (b) management of problematic behaviours, (c) support for the family, and (d) transfer to a specialist eating disorder unit when appropriate and possible. Eating disorders are among the most lethal of all psychiatric disorders and anorexia nervosa is recognised to have a high mortality at an estimated 5.9%. Causes of death vary but complications of malnutrition and suicide appear to be the most common. However, there is little published evidence on fatal outcome in patients with anorexia nervosa, other than death certificate statements, and only rarely is it clear whether the patient died in or out of hospital, and if in hospital, whether in a medical or a psychiatric facility. Moreover, death certificate studies suggest that anorexia nervosa is frequently not mentioned when it should be, and sometimes given as a cause of death when it has no bearing on the death. Patients admitted to medical units with severe anorexia nervosa combine several worrying characteristics. They are usually very unwell indeed. They are sometimes poorly motivated to recover, because that would mean increasing weight. And staff may have limited experience in dealing with this potentially lethal combination. From time to time, concern has been raised about the difficulties encountered by medical units attempting to treat patients with severe anorexia nervosa. A fatal case in point was discussed at length at a national conference in the UK and following that the MARSIPAN project was launched. The present paper is a description of the process that led to the publication of the group’s report,5 and a summary of the main recommendations therein.