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For anyone living with the experience of an eating disorder, either personally, or as a carer, seeking and receiving treatment remains a challenging journey in Australia and most countries around the world.
People living with an eating disorder report that the system is confusing and fragmented; skilled clinicians are scarce; there is no obvious and effective front door to the system; navigation between services and stages of needed treatment remains difficult; and there are many areas of rural, regional and remote Australia with no access to local services. Add to this, the presence of stigma in the health system, which tends to recognise eating disorders of some types, in some age groups, and in some genders, meaning access to care is significantly more challenging for people who don’t present like the stereotype.
The coronavirus disease 2019 pandemic was marked by a notable increase in mental health presentations, particularly for eating disorders, and applied extreme pressure to a mental health system that was already strained. Reports from clinicians and services of being overwhelmed, unable to meet demand, and lacking access to specialist care have only increased in recent years, across general practice, primary care, hospitals, and community mental health settings. Unfortunately, in the eating disorders sector, inadequate resourcing and limited access are longstanding issues, where care provision has historically been seen as a niche area.
In both treatment and research, we have been tinkering at the edges for too long, treating small numbers of people in isolated settings, conducting limited trials of innovative therapies, and training too few professionals. As a result, we have failed to meet demand, or deliver the large-scale impact on outcomes so urgently needed.
Eating disorders are not rare. They affect more than a million Australians. For young Australians aged 15‒19 years, the prevalence rates are markedly higher, sitting at approximately 12%. The size of the unmet need for effective intervention requires bold, scalable solutions.
The time has come for eating disorder identification and treatment to scale — moving beyond niche settings, into mainstream services with broad, accessible reach. Encouragingly, this progress is already underway in certain parts of the country. The New South Wales, Queensland and Victorian governments have had statewide programs for service reform for eating disorders for some years. Victoria has radically overhauled its approach following the Royal Commission, and last year embarked on more ambitious service and research reforms statewide. Other states around the country are at various stages of reform, in a bid to make eating disorders part of the “core business” of the health system.
For federally funded community mental health services, reform has also begun. InsideOut Institute, in partnership with headspace National, has been funded to integrate their evidence-based screening and digital therapies into headspace pathways, allowing headspace clinicians to guide young people through digital therapies without necessarily being an expert in their treatment. Integration of the same tools into the Medicare Mental Health Centres (MMH Centre) treating adults has also begun.
The effective translation of traditional, in-person therapies into digital formats has shown that the core therapeutic components can be delivered in a standardised and scalable way. This ensures that individuals accessing digital therapy receive the same evidence-based care, which in turn, allows clinicians to focus their expertise on other critical aspects of care. This work in community services has been underway for three years. At the time of writing, more than 200 centres (headspace and MMH) nationally were providing access to digital therapies available on the InsideOut eClinic.
The move to digital in almost every area of our life can be wearying at times, and in some cases, digital translation is not the right solution for a problem. However, when it comes to delivering mental health services, particularly for eating disorders, there are compelling reasons to include digital therapy as a core part of the treatment pathway.
Evidence from our work, and that of others, highlights the pivotal role digital therapy can play in expanding access to high quality, life-changing care. There are numerous trials (here and here) that demonstrate that ten sessions of digital therapy program for eating disorders marked by binge eating (bulimia nervosa and binge eating disorder) can achieve the same outcomes (equivalent effect size) as 20 sessions of face-to-face treatment.
The InsideOut Institute eClinic delivers high quality, evidence-based eating disorder treatments through a standardised platform, now accessible to every Australian — anytime, anywhere, and without the need for a referral. The eClinic actively removes barriers, and places the power to access care in the hands of the individual. The Australian Government has fully funded access to these digital therapies, making them free for all Australians. The eClinic aims to remove barriers for health professionals who have reported low confidence and willingness to treat eating disorders, perceiving the need for specialist skill.
The eClinic offers a secure platform for health professionals to connect with their clients, refer them to free, digital therapies, direct carers to free support and training, and access professional training and support for themselves. Health professionals are, therefore, learning about evidence-based therapies for eating disorders in a gradual and supported way, while simultaneously providing their patients with access to quality care.
GPs and other health professionals no longer need to be the expert or trained in evidence-based treatments. They simply need to know where to refer their clients.
Addressing the increasing burden of illnesses such as eating disorders on the health system requires innovative thinking, effective problem-solving, and careful use of available resources. Thoughtful integration of technology into our health pathways will play a key role in addressing this challenge.
Dr Sarah Maguire OAM, Clinical Psychologist and Director, InsideOut Institute, Sydney
Dr Sarah Barakat, Clinical Psychologist, InsideOut Postdoctoral Research Associate and eClinic Research and Evaluation Lead, Sydney.
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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