Severe Cases Only: Apply Within

Let’s not be quiet about this. It’s been swept under the rug for long enough. It’s time to make some noise.

In the coming  months, massive changes will be made in regards to health provisions in Australia. Already there are concerns raised that mental health will not receive adequate funding to make changes so desperately needed to the system. Just last weekend, Get Up! organised a campaign to bombard NSW Premier Kristina Keneally’s office with faxes – a reminder to not let her forget about mental health in this week’s Health Reform discussions. (Get Up!, 2010)

Eating disorders are a massive social issue – and not one which can continue to be ignored. Last year it was reported that five year olds are being admitted to hospital with severe complications of anorexia induced malnutritionand, increasing number of males are developing the condition (news.com, 2009). This is no longer a “teenage girl” illness, nor is it “a lifestyle choice” or “silly little girls seeking attention”. This is a serious disease, which impacts not only one’s physical and mental health, but also their communities; families, friends, teachers, parishioners and employers. According to the Eating Disorders Foundation of Victoria, 1 in 4 people know someone with an eating disorder. (Eating Disorders Foundation of Victoria, 2010).

Fact. Eating disorders have the highest mortality rate of any mental illness. For Anorexia Nervosa it’s 20 per cent. Eating disorders have a suicide rate 32 times higher than the national average. Eating disorders can have long term and devastating health impacts. These are potentially fatal (Eating Disorders Foundation Victoria, 2010). Everyone knows the statistics. They’ve been spoken of often. Yet people hear “eating disorder” and automatically assume that the only ill people – medically or psychologically – are the emaciated shadows of people; usually teenage girls. How very wrong this judgement is for professionals, parents and even patients themselves to have.

A study recently conducted by the Department of Paediatrics at Standford University School of Medicine outlined what those of us with the illness have known for years. Those with an Eating Disorder Not Otherwise Specified (EDNOS); are potentially the “sickest of the sick” – likely to suffer serious medical complications and even be sicker than those with bulimia nervosa
EDNOS is the largest diagnostic cluster of eating disorders; it encompasses everything from someone who binges and purges once a week to a female with behaviours of Anorexia Nervosa who has not yet reached the criteria of amenorrhea (loss of menstruation) for three consecutive months to any other dangerous eating pattern in between.

One out of every 20 Australian women admits to having an eating disorder. Statistics for males suffering the illness are difficult to obtain. According to the ABS, there are 6.98 million people in NSW. Approximately 50 per cent are female. (ABS, 2009) So, given the statistics provided above, this means that approximately 5 per cent of 3.5 million people admit to having an eating disorder. Only 19 per cent of those with anorexia nervosa go willingly to treatment (Eating Disorders Foundation Victoria, 2010) and, with secrecy a huge part of the illness, and the above statistics only representing those who acknowledge their disorder, it’s anyone’s best guess as to how many sufferers there actually are. It is advertised that there are four state-wide publicly funded beds in NSW to treat the illness (CEDD, 2010). In reality it’s far fewer than this – other mental health patients from the Sydney South West Area Health Service take precedence over eating disorder patients and rarely are there enough beds to maintain the program at full capacity.

Patients with the illness are difficult. According to many professionals I’ve spoken to; including staff who work with eating disorders patients directly – eating disorders are the most complicated of all the psychiatric illnesses to treat. They are often the most difficult and manipulative patients. The secretive nature of the disease means that, not only will sufferers to go extreme lengths to hide and deny their illness, but they will also feel as if they do not need or deserve treatment and that their illness does not warrant medical attention. Extremely intelligent people can completely deny that they are ill – even if blood test results, bone density scans, urinalysis and professionals deem it otherwise. This does not mean that these patients do not deserve or need treatment. Rather, this means that they have an illness which prevents them from seeing the severity of their condition during times of illness and should be treated as such – respectfully, compassionately and firmly.

The burden on nursing staff looking after patients with eating disorders is high and no allowances are made to accommodate for the nursing staff rostered on to look after eating disorders patients. I know from personal experience that eating disorder patients are difficult. We are often manipulative, requiring intensive supervision and support. To comprehensively care for an eating disorder patient and six other patients simultaneously is not realistic nor is it fair on the nurse or the patient needing that high level of care and the other patients needing the less intensive support. According to the Centre for Eating and Dieting Disorders, the beds at Royal Prince Alfred Hospital; the only public hospital which admits sufferers from anywhere in NSW, “are usually reserved for severe cases of anorexia and bulimia.”

The fault here does not lie within the staff members themselves – who do an incredible job with very limited resources. It lies in the grossly inadequate funding for psychiatric services nationally, specifically with the funding of eating disorders– lacking not only in NSW, but Australia wide.

There are many horror stories – patients going to the emergency department, being turned away because they “don’t look sick”, only to arrive in an ambulance several hours later with some complication that could have been avoided if they had been admitted for observation in the first place. A dear friend of mine was once turned away from a hospital admission despite having a BMI of 15.1, a sitting heart rate of 160 bpm and a postural drop which caused her to collapse every time she stood up. She was not admitted because her BMI was above the program’s cut off of 14.9 and as such wasn’t deemed medically unstable. This girl was sent to a different state for immediate medical and psychiatric treatment, her family unable to afford to visit her for Christmas. This girl was not from a rural or regional area. She was from a capital city. This is not an isolated incidence. It happens with terrifying regularity.

What is even more concerning is the reaction when sufferers approach allied health care professionals or medical practitioners with concerns that they may be developing an eating disorder. So often it is treated in a blasé manner, sometimes a chortle or an outright response “don’t be ridiculous, you’re hardly thin enough to have a problem.” I’ve had many women write to me and tell me their regrets of not seeking help from an eating disorder friendly practitioner sooner. With regret in their words, they tell me of psychiatrists telling them “you haven’t got a problem if you haven’t got marks on your knuckles from sticking your fingers down your throat” and of emergency departments telling sufferers to contact mental health if they’re so dehydrated they’re not able to hold their heads up or walk in a straight line, but not to bother Emergency again, thank you very much.

It is in these early stages that sufferers are most reachable. It is in these early stages that we can work with people to slow, or even prevent the full onslaught of the most deadly of all the mental illnesses. It is in these early stages, before malnutrition has set in and before the eating disorder delusions and voice have set in, that people are able to work most effectively with treatment teams. It’s here, if the health system worked with people rather than against them, that people have a chance to avoid costly emergency department, outpatient, longer-term medical, longer-term psychiatric and revolving door psychiatric admissions.