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Discharge, Recovery and Relapse

Discharge
What is discharge from Child and Adolescent Mental Health Services (CAMHS)

Discharge from CAMHS means that you will no longer have appointments in CAMHS. Your G.P and other professionals will be told about your discharge, usually by letter.

How is discharge decided?

Discharging from Child and Adolescent Mental Health Services (CAMHS) will be discussed with you as a family. A good discharge should be a joint decision that everyone agrees with. Reasons for discharge are:

  • Treatment is complete and in most cases the patient is in full recovery.
  • Treatment is to continue in another service e.g. in a new location, adult services

What if we need to be re-referred again?

If you need to be referred again in the future your G.P can do this so you can start a new treatment episode with the team. Often you will work with the same therapists as before, but this will be discussed with you at the first appointment.

What is recovery?

Full recovery can be summarised within 3 areas:

  • Physical – Weight restored or stable, regular menstruation and or normal pubertal development, growth resorted, bones recovered.
  • Behavioural – Normal eating /exercise and other compensatory behaviours. (Normal being what was normal before the eating disorders and what is normal in your family)
  • Emotional/Psychological – Healthy attitudes to weight and shape, able to deal with emotions and feeling as a similar aged young person.

Full recovery also means that young people lead a normal life for someone their age. The majority of young people who have had eating disorders will fully recover and be discharged when fully recovered.   Partial Recovery is when young people continue to have some eating disorder symptoms, see examples below:

  • Physical – Maintain a low weight, but without immediate risk, menstruation may be irregular or absent, puberty disrupted.
  • Behavioural – The young person does not eat a normal variety of foods or does not eat in a normal way. May exercise or have other behaviours that are driven by the need to control weight.

Emotional/Psychological - Concerns regarding weight and shape persist. Emotions and self esteem may still be problem areas. It is often this area that takes the longest to become normal. In partial recovery the young person, in other ways is managing to have a fairly normal life, for example they are going to school and having satisfactory social lives. It is possible that a decision is made to discharge a young person even though they are only in partial recovery. The risk of a relapse into more severe eating disorders is higher if discharge occurs in partial recovery.

Relapse

What is relapse?

A relapse of the eating disorder is when symptoms; physical, behavioural and psychological, worsen again. Relapse is not failure and is often considered part of the cycle of recovery.

When might it happen?

It mostly happens in the 1st year of apparent recovery. Although it can happen within the 1st 5 years after recovery. Young people are especially vulnerable at times of stress.

Who might relapse?

Those who are not in full recovery are more at risk of relapse. Although of those that fully recover we do not know why some people relapse whilst others do not. There will be some relapse in approximately 1 in 3 young people.

What do we do if relapse occurs?

Before discharge a relapse plan is likely to have been put in place. Its content will be very individual to the young persons needs.

What I need to do to prevent set backs?

Examples might be: eat regularly, beware of exercising alone, and do not comparing myself to others, keep meeting up with friends and maintaining my interests.

What might increase the risk of set backs for me?

Examples might be: weight changes, going to university, feeling alone.

What are my early warning signs of a relapse?

Examples might be: Changes in eating; not eating certain foods, not eating regularly, avoiding eating out. Thinking about weight and shape issues; dissatisfaction with weight and shape and wanting to change it. Physical changes; weight changes, menstrual cycle changes etc

My action plan for dealing with signs of relapse

Examples might be: Identify what is happening, talk about it to Mum/Dad, and get a plan in place straight way that deals with the areas that have changed. For example; eat regularly, stop exercise/vomiting, keep talking about difficulties, stop watching food programmes on television, and go out with friends.  

Useful information if further action is needed due to a relapse

Acting quickly with the relapse plan should improve things quickly. If you have any concerns, even though you have been discharged from CAMHS, your case manager or therapist would be happy to give you advice and support or the Connect-Eating Disorder Team (0141 277 7407) Other support lines such as those at www.b-eat.co.uk and other websites on the website page of this site will also offer support. If there are no improvements within a short period of time, re-referral should be strongly considered.