Doctors tackle systemic barriers in eating disorder treatment

Eating disorders fall outside the normal medical treatment model, making it very difficult for patients to access treatment and care in Australia and putting additional pressure on doctors.

Many doctors find it difficult to treat eating disorders, whether they are general practitioners, pediatricians or psychiatrists.

We argue that eating disorders do not fit neatly into a medical model, which makes treatment and care options very difficult, especially given the constraints of the healthcare system.

Eating disorders have among the highest death and suicide rates of any mental illness (here), but their relative importance has been neglected by medical research and health care systems until recently.

Indeed, mental health care for potentially serious illnesses remains severely rationed in Australia, shrouding the treatment of eating disorders in myth and mystery for many patients and carers.

Doctors can also be forgiven for thinking it’s a mystery, which begs the question: how many people actually get good quality care?

Currently, only 50% of people in need of mental health care receive it, and only 15% of this care is of minimally adequate quality (here).

This means that treatment for potentially serious mental illness is often withheld until it can no longer be withheld, and illnesses exhibit greater chronicity and severity when finally seen.

For eating disorders, this equates to a loss of more than 3.3 million years of healthy life, a significantly reduced quality of life, an increase in the number of years lived with disability and increased loss of life (here).

How would we react if cancer treatment was suspended until the cancer was in its advanced or final stage?

The impact on society

Despite some significant oases of reform, public and political apathy has allowed this scenario to persist, even though it would be a clearly unacceptable scenario for illnesses that fall outside the psychiatric spectrum.

This has contributed to a corrosive effect on society and the avoidable loss of lives and the nation’s “mental wealth”.

Unfortunately, being denied access to specialist care until the later stages of the disease is the reality for many young people with eating disorders (here), at which time disease took hold of body and mind and undermined the normal, healthy desire to heal.

We see the grim reality of this rationed access to mental health care in our daily clinical practice, increasing risk and harm to unbearable levels.

The trauma of this approach is well known (here).

See both sides of the fence

For some of us in the mental health profession, we have also been on both sides of the fence, experiencing the treatment of eating disorders from the perspective of clinicians and patients.

This makes us even more determined to change the approach to treating eating disorders.

Indeed, entering the psychiatric profession as a physician with lived experience of anorexia nervosa is challenging, but it can also provide great insight.

As a mentally ill patient, there is often a sense of helplessness, especially when in the depths of a serious eating disorder.

You can go years without being diagnosed and believe that your relationship with food is normal (here). Eating disorders can also present in different ways with symptoms ranging from restriction to binge eating. There is no single experience.

When the diagnosis is finally made, the mind can become so wrapped up in distorted food cognitions that accepting treatment and the need for change can be nearly impossible.

For many, this can become a lifelong struggle.

Availability of care

Depending on where you live and your financial situation, the availability of specialized mental health support can also present a significant challenge (here).

Although they represent a third (here) of the population, access to specialist support for psychiatric and eating disorders for Australians in rural, regional and remote areas remains poor (here).

And when you look at what treatment entails, it’s often very constraining and traumatic for the individual concerned. Something that was evident from personal experience as a patient and doctor.

Early intervention and treatment would likely increase the chances of recovery overall.

Clinicians have to compromise

As clinicians working within these systems, compromises are made on the care provided due to limited resources and ongoing workforce shortages.

When it comes to complex diseases, there is no “magic pill” for patients living with an eating disorder, requiring the involvement of a multidisciplinary team and, nowadays, often due late interventions and treatments, long and costly hospitalizations (here).

With additional requirements for healthcare workers (here) and the increase in mental illnesses as a result of the coronavirus disease 2019 (COVID-19) pandemic (here), many psychiatrists and mental health clinicians are vicariously exhausted and traumatized by these systemic constraints (here).

Eating disorders outside the medical model

Finally, we are all too aware that there have been few advances in the treatment available for people with eating disorders.

Even for people working in the field of mental health, knowledge of eating disorders remains a subspecialty skill.

Similarly, eating disorders do not fit well into a medical model, which many of our physician and pediatrician colleagues may find uncertain and troubling (here).

It is possible for milder and early cases to access care through primary care and Headspace; however, the expertise and evidence base to support and guide effective intervention at this early stage has not yet been fully assembled.

Innovative research is essential to understanding the nature of these diseases, to exploring and creating new approaches to prevention and treatment, and to translating them into vastly expanded platforms of coded healthcare.

It’s time to change the paradigm

While additional federal and state funding is crucial, it alone is not enough to provide the care needed for people with eating disorders.

We must invest in new knowledge and develop it in the form of empirical research.

We must commit to providing a coordinated and integrated therapeutic response to the management of eating disorders across all medical specialties and health services.

In Australia, we are fortunate to have the basic national infrastructure to open channels for early intervention, which can be strengthened by multidisciplinary community care systems. This is necessary to support those who correspond to the “missing middle”: young people who are not sick enough to have access to public psychiatric services.

Ultimately, we must transform the field of eating disorders and elevate it to the level of importance it commands on the spectrum of mental illness, especially among young people.

Our young people deserve it.

Dr Tahnee Bridson is Queensland’s 2022 Young Australian of the Year and founder of Hand-n-Hand Peer Support Inc. She is a psychiatry registrar and has lived experience of anorexia nervosa.

Dr Skye Kinder is the 2019 Victoria Young Australian of the Year and a Forbes 30 Under 30 winner for her social impact in the Asia-Pacific region. She is a psychiatry registrar.

Professor Patrick McGorry AO was voted Australian of the Year 2010. He is Executive Director of Orygen, Consultant Psychiatrist and Professor of Youth Mental Health at the University of Melbourne.

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