OPEN LETTER: To Parliamentary Friends of Eating Disorder Awareness

To Parliamentary Friends of Eating Disorder Awareness,

InsideOut Institute for Eating Disorders (IOI) thanks you for standing together today in bipartisan support of increased action for people with these illnesses. Thank you for using your platform to bring this under-serviced area of health to the nation’s attention.

We stand with the families and individuals who came forward and were documented in last week’s Four Corners episode. We acknowledge the significant challenges trying to access care in a system that is not functioning as it should. Our hearts go out to those who have lost family members and those struggling to avoid this.

The pandemic has seen a dramatic increase in the numbers of people with eating disorders presenting for treatment across the country. The system has never before had to cope with such pressure and is ill-equipped to deal with it. We know that pressures on the health and mental health system have both grown through the pandemic, but data suggests that this growth has been particularly marked for eating disorders.

In very recent years, State and Federal governments have started to invest and build the system of care for this illness group. But the reality is there is much work still to be done.

What our health system desperately needs is a properly organised and funded whole of health system response to eating disorders including hospitals, emergency departments, community care and our primary care sector. In some places this work has begun and must be built upon, not undermined.

The purpose of any modern health system is to treat as many people as possible as early in illness as is possible, keeping them as close to home as can be managed, producing the best possible health and quality of life outcomes. Community care is able to both treat people early to prevent severe illness developing and to keep those who are severely ill out of hospital unless medically indicated. Many eating disorders can be completely cured if evidence-based community treatment is received.

Federal and state funding can be most effectively spent by giving clinicians on the ground accessible and high-quality training in evidence-based care and making that care accessible to the one million unwell Australians who so desperately need it.

We need to upskill GPs to catch eating disorders early and intervene appropriately. We need to support and organise our community psychologists, dietitians, psychiatrists, and mental health providers to use the Medicare items in an effective way, delivering evidence-based care as part of a cohesive team.

Hospital and residential care facilities are important – we need them. There are desperate families with members who are profoundly unwell who, of course, need access to high quality hospital or residential care for life-saving intervention and short-term reprieve. A number of residential facilities have already been funded in Australia, however, there is not yet a strong evidence-base to support that residential facilities lead to sustained recovery(1,2). Staff in hospitals and emergency departments all over the country require upskilling to better identify and manage people with eating disorders. Importantly, those who are severely ill are small in number compared to the many thousands of others with eating disorders in our communities. 

There is a considerable evidence-base supporting recovery through community care – and that is where we should be focusing our public investment.

In competitive funding environments, community care packages, including for intensive services, can provide care to far greater numbers of people and are likely to produce recovery rates that have not yet been demonstrated in any other care setting.

Surely the goal should be to keep people from getting so profoundly unwell that their only option is a hospital. To do that, we need to better fund and develop community care. We won’t keep people out of hospital by building new ones, we keep people out of hospital by providing proper high-quality care in the community, while upskilling staff in the hospitals we have, to provide accessible quality time-limited admissions.

We are advocating, alongside those with lived experience of an eating disorder and their loved ones, for all people with eating disorders regardless of body size and co-occurring condition, and across all diagnostic categories, to have access to:

• Comprehensive community treatment to keep people out of hospital, working towards recovery as the evidence base supports 
• Timely admission and adherence to protocols for re-nourishment and medical stabilisation on medical wards
• Appropriate trained medical staff, skilled in re-nourishing protocols, trauma-informed treatment practices and client-centred treatment
• Integrated treatment approaches between our medical and mental health services
• Early diagnosis and access to prompt evidence-based intervention 
• A health system where eating disorders are part of the core business of all parts of the system 
• Increased funding for research activities to give people access to innovative treatments under clinical trial and to lead to breakthroughs 
• Equity of access to respectful, quality care-free of stigma, judgement, and shame

There is much work to do, but the development of the system we need has begun and we must keep advocating for funding for treatments that will benefit all, prevent deterioration and above all work.

IOI looks forward to the inaugural meeting led by Parliamentary Friends of Eating Disorder Awareness group.

Signed by:

InsideOut Institute for Eating Disorders

References 

1. Kotilahti, E., West, M., Isomaa, R., Karhunen, L., Rocks, T., & Ruusunen, A. (2020). Treatment interventions for severe and enduring eating disorders: systematic review. International Journal of Eating Disorders, 53(8), 1280-1302.
2. Peckmezian, T., & Paxton, S. J. (2020). A systematic review of outcomes following residential treatment for eating disorders. European Eating Disorders Review, 28(3), 246-259.