Doctors fight systemic hurdles in treating eating disorders

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

Many doctors find it difficult to treat eating disorders, whether they are physicians, general practitioners, paediatricians or psychiaristrists.  

We argue that eating disorder conditions don’t fit nicely into a medical model, making treatment and care options very challenging, particularly given the constraints with the health system.

Eating disorders have among the highest mortality and suicide rates of all mental illness (here), yet 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 treatment for eating disorders in myth and mystery for many patients and carers alike.

Doctors can also be forgiven for thinking it is a mystery, prompting the question: how many people actually receive good quality care?

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

This means that the treatment of potentially serious mental illness is frequently withheld until it can no longer be denied, and that illnesses present with greater chronicity and severity when eventually seen.

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

How would we respond if cancer treatment was withheld until the cancer was in its late or final stages?

The impact on society

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

This has contributed to a corrosive effect on society and to the preventable loss of life and “mental wealth” of the nation. 

Unfortunately, denying access to specialist care until the late stages of illness is the reality for many young people with eating disorders (here), by which time the illness has taken full hold of the body and mind and undermined the normal healthy desire to get well.

We see the grim reality of this rationed access to mental health care in our daily clinical practice, escalating the risks and harms to an insupportable level.

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

Seeing both sides of the fence

For some of us within the mental health profession, we’ve also been on both sides of the fence, experiencing the treatment of eating disorders from clinician and patient perspectives.

This makes us even more determined to change the approach to eating disorder treatment.  

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

As a patient with mental illness, there is frequently a feeling of helplessness, especially when in the depths of a severe eating disorder.

One might spend years undiagnosed and believing that their relationship with food is normal (here). Eating disorders can also present in many different ways with symptoms ranging from restriction to binge eating. There is no one-size-fits-all experience.

When the diagnosis is finally made, the mind may be so consumed by the distorted eating cognitions that accepting treatment and the need for change can be near impossible.

For many, it can become a lifelong struggle. 

Availability of care

Depending on where you live and your financial status, availability of specialist mental health support can present a significant challenge too (here).

Despite comprising one-third (here) of the population, access to specialist psychiatric and eating disorder support for rural, regional and remote Australians remains poor (here).

And when we look at what treatment entails, it is often highly restrictive and traumatic for the individual concerned. Something that has been evident through personal experience as both a patient and doctor.

Early intervention and treatment would, on the whole, likely increase the chance of recovery.

Clinicians having to make compromises  

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

As complex illnesses, there’s no “magic pill” for patients who are living with an eating disorder, requiring multidisciplinary team involvement and, at present, due often to delayed intervention and treatment, long and costly inpatient hospital stays (here).

With the additional demands placed on health care workers (here) and the rise in mental illness as a consequence of the coronavirus disease 2019 (COVID-19) pandemic (here), many psychiatrists and mental health clinicians are burnt out and vicariously traumatised by these system constraints (here).

Eating disorders sitting outside the medical model

Finally, we are all too aware that there have been few advancements in the treatment available to people experiencing eating disorders.

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

Eating disorders similarly don’t fit nicely into a medical model, which many of our physician and paediatrician colleagues can find uncertain and unsettling (here).  

It is possible for milder, 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 understand the nature of these illnesses, to explore and create novel approaches to prevention and treatment, and to translate these into greatly expanded platforms of codesigned health care. 

It is time for a paradigm shift

While additional federal- and state-based funding is crucial, it alone is not sufficient to deliver the care needed for people living with eating disorders.

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

We must commit to the delivery of a coordinated and integrated treatment response to eating disorder management across medical specialties and across health services.

In Australia, we are fortunate to have the basic national infrastructure to open early intervention channels, which can be strengthened through multidisciplinary community care systems. This is required to support those who fit into the “missing middle”: young people who are not sick enough to gain access to public psychiatry services.

Ultimately, we need to transform the field of eating disorders and elevate it to the level of importance it commands within the spectrum of mental illness, particularly for young people.

Our young people deserve this.

Dr Tahnee Bridson is the 2022 Queensland Young Australian of the Year and Founder of Hand-n-Hand Peer Support Inc. She is a Psychiatry Registrar with lived experience of anorexia nervosa.

Dr Skye Kinder is the 2019 Victoria Young Australian of the Year and a Forbes 30 Under 30 honoree for Social Impact in the Asia Pacific. She is a Psychiatry Registrar.  

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

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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