Eating disorder service mapping project

Eating Disorder Service Mapping Project - October 2006 (PDF File 295KB)

This Report presents the results of a project that mapped services for people with eating disorders. The mapping exercise was a government commitment in response to recommendations of the Body Image Inquiry Report, tabled in Parliament in September 2005.

While acknowledging the importance of health promotion and health promotion activities focused on healthy eating, the Eating Disorders Service Mapping Report is focused on the range of existing health services that provide interventions for people with eating disorders. This includes programs for people with body image concerns as well as services for persons affected by the most severe eating disorders. The Report encompasses private, not-for-profit and public sector services, with a major focus on relevant state-funded mental health services.

A stepped care model is used to analyse the nature and adequacy of existing services. This approach assumes that treatment should match patient need, with the most complex and severe conditions being treated by the most specialised services and vice versa. According to this model, the less severe conditions should be treated at the primary care level, whereas specialist mental health and health services should treat moderate to severe disorders, and tertiary level specialist care focus on the most severe conditions.

Use of the stepped care model highlights issues of accessibility and availability of treatment at the different levels of care. The Report identifies service system problems at each level of care in relation to eating disorders. For instance, GPs are the key primary health practitioners, with a pivotal role in recognising problematic eating; assessing its severity, and organising appropriate treatment. It would appear however, that only a minority of GPs are willing and able to undertake this role. Community health services are another source of primary care, particularly for those with limited means, yet their staff might not be skilled in identifying and treating disordered eating. Further, community health service programs may not be in place for people with body image concerns.

Secondary level care is typically required for moderate to severe eating disorders. A person in this situation would usually be referred by primary health providers to the private or public mental health sector for mental health treatment. Paediatricians are also frequently consulted regarding children and adolescents. If the person's physical health is compromised, admission to a paediatric or general adult medical ward may also be necessary.

Although important, access to secondary care from public or private mental health services is not straightforward for the treatment of eating disorders. For instance, most private psychiatrists practise only in certain parts of metropolitan Melbourne, and bulkbilling is rare. Use of private psychologists and dietitians is costly, especially for those with little disposable income and no private health insurance cover. Additionally, private health insurance is necessary to meet the costs of private psychiatric inpatient care and day program attendance. Furthermore, fees are charged for attendance at programs run by private foundations such as the Bronte Foundation and the Oak House.