THE USE OF GUARDIANSHIP LEGISLATION FOR ANOREXIA-NERVOSA - A REPORT OF 15 CASES

Objective: This paper investigates compulsory treatment under guardian ship legislation for 15 anorexia nervosa patients admitted to four eat ing disorders units in New South Wales (NSW), Australia, between 1991 and 1994. Method: A retrospective follow-up was conducted. This involv ed an analysis of sociodemographic, clinical, eating and weight histor y, and Guardianship Order details obtained from medical records. This small sample was compared to a larger sample of anorexia nervosa patie nts admitted voluntarily to a specialised eating disorder unit in NSW. Further follow-up included a structured interview using the Morgan-Ru ssell Assessment Outcome Schedule at least 1 year after admission for compulsory treatment. Results: For those treated involuntarily, a larg er number came from metropolitan Sydney and a larger percentage were u nemployed, were purgers and required specialist medical consultations. A significantly higher proportion came from higher socioeconomic grou ps, and the duration of stay in hospital while patients were under gua rdianship was significantly greater. A high degree of comorbidity was noted. There were similarities between those treated involuntarily and those treated voluntarily for the source of referral, marital status and Body Mass Index on admission and discharge. Only three patients ac cepted a follow-up interview using the Morgan-Russell Outcome Schedule . Two of them had made a good recovery. Conclusions: It was noted that the guardianship sample comprised a more severely ill group than anor exic patients treated voluntarily The nature of guardianship legislati on compared to mental health law was discussed and advice offered to c linicians contemplating and implementing compulsory treatment.