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New study reveals Australia's deadliest mental illness receives lowest research spend

21 May, 2023

KEY POINTS 

  • 1 in 20 Australian adults has an eating disorder (1,2); anorexia nervosa is the deadliest of the mental disorders (3–6) and one of the most expensive to treat in the public health system (1,7–10). 
  • Per affected individual, eating disorders receive funding equivalent to 1% of that given for schizophrenia research (despite a fourteen-fold higher prevalence); and 10.5% of the research funding given to depression 
  • Overall, mental ill-health is responsible for up to 22% of total disease burden in established market economies (11) but mental health receives less than 10% of total Australian publicly funded medical research.  

Anorexia nervosa is the deadliest of the mental disorders (3–6) and among the most expensive to treat in the public health system (1,7–10), yet eating disorders receive the lowest spend of mental health research funding, according to new research published in the Lancet Regional Health journal. 

The analysis of funding allocations made by Australia’s three national medical research funding bodies (NHMRC, ARC and MRFF) over 13 years (2009-2021) reveals eating disorder research and treatment is consistently underfunded, contributing to protracted illness, a lack of treatment innovation, high death rates and significant health system costs.  It is on every metric the most inequitably funded of the five major mental illness groups examined, having both the lowest actual dollar investment and the lowest per affected individual investment.                     

InsideOut Institute Director Associate Professor Sarah Maguire OAM says the lack of funding has “serious and long-standing impacts.” 

“Despite a high mortality rate, increasing hospital presentations and attention from government, funding for eating disorders research hasn’t budged for more than a decade. This has led to a much smaller and poorly developed scientific community in this area, and a lack of innovation in treatments, which results in unnecessary illness and death,” said A/P Maguire of the University of Sydney. 

The analysis found a research spend of $2.05 per affected individual for eating disorders compared with $4.86 for anxiety disorders, $19.56 for depression, $32.11 for autism (which is currently funded under the mental health category) and $176.19 per affected individual for schizophrenia. 

In actual dollar terms, both anxiety and depressive disorders get over seven times the investment in research received by eating disorders and the other two diagnostic groups analysed got double or more.  

Burden of Disease (BoD) estimates are generally a primary consideration for medical research funding (12–15), but the analysis found that when it comes to eating disorders, there is a stark funding disparity relative to disease burden. 

Study co-author and University of Sydney Researcher Emma Bryant says this mismatch could be due to stigma and a lack of robust epidemiological data. 

“The lack of research investment means that what we know, and ask, about eating disorders in Australia is significantly less than other mental illnesses - we have no robust national epidemiological data, eating disorders have been excluded from national surveys, excluded from other routine mental health collections and mortality is poorly recorded. So, it’s very hard to get an accurate picture of who has an eating disorder, what kind of treatment they are getting and whether that treatment is effective”  

“We believe official burden of disease figures for eating disorders are seriously underestimated, which has a flow on effect to the funding allocated,” said Ms. Bryant. 

The analysis by Bryant, Maguire and the team of researchers from the University of Sydney’s InsideOut Institute for Eating Disorders, also found significant discrepancy between research funding dollars and disease burden associated with the mental and neurodevelopmental health in general. 

Mental ill-health is responsible for up to 22% of total disease burden in established market economies (11). In Australia, mental ill-health causes the third highest all-age disability burden, and notably, the highest for young people and the health system cost of mental disorders doubles every seven years (16). But mental health receives less than 10% of total Australian public medical research funding (17,18). 

A/Prof Maguire says eating disorders are getting a tiny portion of what is already too little an investment in the mental health of Australians. 

“A systemic whole-of-government approach is needed to address inadequate investment in mental illness more broadly and particularly for illness groups such as eating disorders. Equitable, priority-driven allocation of medical research funding, commensurate with the true burden of illness, is essential to drive improvements in clinical care and the health of all Australians," said A/P Maguire. 

Declaration: This work was in-part funded by the Australian Government Department of Health and the National Eating Disorder Research & Translation Strategy. The funder was not directly involved in informing the development of the current study. 

Anyone needing support with eating disorders or body image issues is encouraged to contact:  

  • Butterfly National Helpline on 1800 33 4673 (1800 ED HOPE) or support@butterfly.org.au    
  • For urgent support call Lifeline 13 11 14   

References:

  1. Butterfly Foundation. Paying the price - The Economic and Social Impact of Eating Disorders in Australia [Internet]. Sydney; 2012 [cited 2020 Oct 16]. Available from: https://www2.deloitte.com/au/en/pages/economics/articles/butterfly-report-paying-price-eating-disorders.html 

  2. Hay P, Girosi F, Mond J. Prevalence and sociodemographic correlates of DSM-5 eating disorders in the Australian population. Journal of Eating Disorders. 2015 Apr 25;3(1):19.  

  3. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Archives of General Psychiatry. 2011 Jul 1;68(7):724–31.  

  4. Birmingham CL, Su J, Hlynsky JA, Goldner EM, Gao M. The mortality rate from anorexia nervosa. International Journal of Eating Disorders. 2005;38(2):143–6.  

  5. Chang CK, Hayes RD, Broadbent M, Fernandes AC, Lee W, Hotopf M, et al. All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study. BMC Psychiatry. 2010 Sep 30;10(1):77.  

  6. Fichter MM, Quadflieg N. Mortality in eating disorders - results of a large prospective clinical longitudinal study. International Journal of Eating Disorders. 2016;49(4):391–401.  

  7. Tseng MCM, Tu CY, Chang YT. Healthcare use and costs of adults with anorexia nervosa and bulimia nervosa in Taiwan. Int J Eat Disord. 2021 Jan;54(1):69–80.  

  8. Christensen MK, Lim CCW, Saha S, Plana-Ripoll O, Cannon D, Presley F, et al. The cost of mental disorders: a systematic review. Epidemiol Psychiatr Sci. 2020 Aug 18;29:e161.  

  9. Crow SJ, Nyman JA. The cost-effectiveness of anorexia nervosa treatment. Int J Eat Disord. 2004 Mar;35(2):155–60.  

  10. Deloitte Access Economics, Harvard University. Social and economic cost of eating disorders in the United States of America. 2020;92.  

  11. Andrews G, Sanderson K, Beard J. Burden of disease. Methods of calculating disability from mental disorder. Br J Psychiatry. 1998 Aug;173:123–31.  

  12. Mitchell RJ, McClure RJ, Olivier J, Watson WL. Rational allocation of Australia’s research dollars: does the distribution of NHMRC funding by National Health Priority Area reflect actual disease burden? Medical Journal of Australia. 2009;191(11–12):648–52.  

  13. Tuffaha HW, Andronis L, Scuffham PA. Setting Medical Research Future Fund priorities: assessing the value of research. Med J Aust [Internet]. 2017 Feb 6 [cited 2022 Feb 5];206(2). Available from: https://www.mja.com.au/journal/2017/206/2/setting-medical-research-future-fund-priorities-assessing-value-research 

  14. First report on the National Health Priority Areas, summary, Summary [Internet]. Australian Institute of Health and Welfare. [cited 2022 May 22]. Available from: https://www.aihw.gov.au/reports/health-care-quality-performance/first-report-national-health-priority-area-summary/summary 

  15. Commonwealth of Australia. Australia’s Long Term National Health Plan. ACT; 2019 p. 24.  

  16. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes : summary report. 2019.  

  17. Batterham PJ, McGrath J, McGorry PD, Kay-Lambkin FJ, Hickie IB, Christensen H. NHMRC funding of mental health research. Med J Aust [Internet]. 2016 Oct 17 [cited 2021 Jun 28];205(8). Available from: https://www.mja.com.au/journal/2016/205/8/nhmrc-funding-mental-health-research 

  18. NHMRC. Research funding statistics and data | NHMRC [Internet]. 2021 [cited 2021 Jun 27]. Available from: https://www.nhmrc.gov.au/funding/data-research/research-funding-statistics-and-data