The report, of which the second edition is available online at www.​rcpsych.​ac.​uk/​pdf/​CR189_​a.​pdf (accessed 22/11/14) was endorsed by a number of important bodies, listed in Table 1.2.

MARSIPAN covered only adults over 18, and hot on its heels came Junior MARSIPAN (http://​www.​rcpsych.​ac.​uk/​files/​pdfversion/​cr168.​pdf) (accessed 22/11/14), covering the management of young people under 18 with severe AN. The challenges for the Junior MARSIPAN group differed somewhat from those in adult services. Firstly, the threshold for response to children differs, in that young people are brought to treatment whether they want it or not. Consequently death rates overall are low and stories of death and collapse are typically in young adults. With young people, the key issue is ensuring that treatment is effective and does not undermine the young persons’ or their family’s confidence in professionals in such as way that it will impact recovery. In other words, the aim is to prevent chronic illness by effective early intervention. Secondly, at least in the UK, the challenges of service organisation for young people are even more evident because paediatricians have a substantial role in care, particularly with children (Nicholls et al. 2011). So whilst transition to a medical ward is a rare event for adults with eating disorders, admission to paediatric settings is far more common for young people. The level of knowledge and expertise amongst paediatricians should therefore be proportionately greater. However, it is, sadly, often unsatisfactory (Hudson et al. 2013). Similarly paediatric wards should be, but despite growing need in this age group (Hargreaves and Viner 2014) are often not, better adapted to the care of adolescents. Thirdly, the biggest challenge of all in the provision of effective and comprehensive healthcare for young people with eating disorders, is that inpatient psychiatric care for young people, at least in the UK, is often divorced from outpatient care. Hospital admission thus involves transition to a new service and a new team, often far from home, with limited capacity for day treatment as a step-up to or step-down from inpatient care. Consequently admissions are lengthy, and transitions fraught with risk. Junior MARSIPAN’s focus therefore was on clarifying roles and responsibilities for everyone involved in the care of young people with eating disorders, including the role of the family, and providing clear guidance that could be incorporated into protocols for decision-making, assessing risk, admission thresholds and locations and managing key medical and behavioural challenges. Getting it right in the early stages can be crucial in changing the course and outcome.

These guidance documents have been widely distributed and their use is increasing. Knowledge and awareness amongst paediatricians is definitely increasing, and there are proposed changes to paediatric training as a result. However, it is probably the case that the majority of front line medical staff who initially see adults with severe AN have no knowledge of the guidance. There are still reports of young adults being admitted to hospital where the staff know little about eating disorders and where their treatment is not appropriate to the patients’ needs. Perhaps this book will help raise awareness enough to make a difference. We hope so.