18/07/2017. An Integrated Community Approach to Eating Disorders FACT 1# EATING DISORDERS ARE COMMON

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1 An Integrated Community Approach to Eating Disorders Eating Disorders Treatment and Support the Future through PHN s Christine Morgan National Director, National Eating Disorders Collaboration CEO, Butterfly Foundation MY PHN Conference CAIRNS 8 July 2017 NATIONAL COLLABORATION (NEDC) A nationally consistent, evidence-based approach to the prevention and management of eating disorders in Australia Established 2009 collaboration between experts, clinical professionals and those with a lived experience led by Steering Committee of leading Australian eating disorder experts Evidence based effective practice within long term approach Presenting information that is accessible and relevant Consensus and ongoing in put in to the evidence base Dissemination, engagement and implementation Membership (over 2200 members) Websites Communications (3800+ subscribers, social media) Workforce development Resource development Eating disorders are serious mental health issues that impact every aspect of life from psychological and social wellbeing to physical health and medical complications They are characterized by feelings of anxiety, hopelessness, depression, selfhatred, tormenting voice of a harsh inner critic There is a tyrant in my head screaming abuse at me 24/7 4 specified eating disorders All genders, ages, sizes, shapes & cultural backgrounds Symptoms & diagnosis may vary over time Affect approx. 9% of the population in their lifetime Rates increasing over last 30 years FACT 1# COMMON I was recently asked to sum up my experience of anorexia nervosa in one sentence actually, I can do it in just one word ISOLATION...you feel completely alone I feel like I have been hit by a truck I m living a nightmare 1

2 You cannot tell by looking at someone that they have an eating disorder Some of your clients have eating disorders FACT 1# COMMON ALL Eating Disorders: Significant physical & mental health consequences Severe medical complications Increased mortality rates; one of highest of all psychiatric illnesses; over 12 times higher than that for people without EDs FACT 2 # SERIOUS If you work with young people, adult women, athletes, people with obesity, diabetes or people with mental health issues like depression and anxiety, then you are likely to work with eating disorders frequently Main causes of mortality: Suicide Gastrointestinal complaints Infection Severe emaciation Complex interplay of risk factors Environmental Biological Psychological FACT 3# COMPLEX Starvation Impact of poor nutrition on brain Personal Values Value placed on the ED; pride in self discipline (AN); value placed on related activities (e.g. Sport, modelling) Stress Impact of stress and anxiety on brain, perception and choices Inner Critic Harsh, demanding inner voice Habit Repeatedly reinforced behaviour becomes automatic Personal Traits Perfectionism, anxiety, obsessive or impulsive traits Social Pressures Impact of social environment and relationships Psychiatric Comorbidity Depression, anxiety, OCD, personality disorders Placed on a continuum of healthy approaches Life Experience Lessons from past experience including experience of treatment Hard Work Effort required to maintain or hide the ED; effort required to recover; effort required to regain the ED self Loss of Alternatives Lack of alternative goals, identities, coping strategies and supportive relationships 2

3 FULL RECOVERY is POSSIBLE FACT 4# Path of recovery is a unique, personal journey Support the person by listening to them and helping them to find & respond to a treatment program that suits them Best type of treatment is one that is long term & focussed on the needs of the person with the ED & their family or circle of support 90% of patients given an effective treatment within 3 years of illness onset have a positive outcome at 5years TREATABLE NEDC RESOURCES GPs Counselling Nursing Midwives and Perinatal Teachers and Schools Sporting professionals/coaches Pharmacists Dentists Caring for Someone with an Eating disorder HELP FOR CLIENTS & HEALTH PROFESSIONALS National Helpline for Eating Disorders 1800 ED HOPE ( ) Monday Friday (AEST) (support@thebutterflyfoundation.org.au ) Webchat (see ) Online support groups Online carer psychoeducation INFORMATION & FURTHER TRAINING Australian and New Zealand Academy for Eating Disorders: The Butterfly Foundation Journal of Eating Disorders Centre for Eating and Dieting Disorders (NSW) Centre for Excellence in Eating Disorders (Victoria) Centre for Clinical Interventions (WA) Mental Health First Aid Australia 3

4 REASONS FOR PRIORITISING Relatively common, occurring across community EDs are not self limiting Serious long term health consequences, chronicity, mortality risk and health care costs Impacts on the safety and effectiveness of other treatment Overlap with three priority areas for preventative primary health care: mental illness, obesity and diabetes Most effective treatment is early in illness Treatment needs to be integrated, multidimensional and multidisciplinary and in community Recovery is possible PRIMARY C: FIRST PORT OF CALL People with an eating disorder are most likely to seek help for a related health issue. Common initial or presenting concerns to primary care are: Weight gain, loss or fluctuations Seeking weight loss treatment or weight loss aids Related or high risk illnesses or issues Fainting, dizziness or poor circulation Heart issues like palpitations Obesity related issues Diabetes Injuries Decreased immune system (eg frequent colds) Gastro intestinal complaints Reflux, heartburn Bloating IBS symptoms Purchasing of large volumes of laxatives, antacids Infertility or menstruation concerns Polycystic Ovarian Syndrome Seeking fertility treatment Amenorrhea Other mental health issues Stress and anxiety Depression Substance abuse Dental concerns Increased/unexpected erosion Discoloration Lesions or abrasions Child/adolescent growth failure Fallen off own growth curve Delayed puberty STEPS TOWARDS EFFECTIVE TREATMENT Safe treatment of eating disorders addresses all aspects of illness: physical, psychological, nutritional and functional Medical Stabilisation Restoration of weight/nutritional rehabilitation Psychotherapy Supporting recovery in the community Effective treatment is person centred and individually tailored to the needs of the person and their family For effective treatment, integration & collaboration is required; Physical and mental health services Public and private health services Across professional disciplines and treatment approaches Treating comorbid conditions and symptom medical issues Entry Points Self Directed Care Integrated Programs Coordination PRIMARY C SERVICE ELEMENTS Outreach and prevention Information and education Screening, assessment and referral Guided self help Recovery and family support Outpatient treatment Community based clinicians and practitioners Case coordination and professional collaboration Referral pathways 4

5 PRIMARY C CHECKLIST FOR Core Business Identified role responsibilities for eating disorders Service planning includes investigation of ED needs in primary care setting Risk management strategies and policies relating to mental health include eating disorders Eating disorders included in screening and assessment tools/processes Capacity and Capability Resource and time allocation for those working in mental health Ongoing access to professional development Staff meet core competencies and competencies are integrated in to requirements for services Services provided are evidence based Resources and tools available to staff to identify key information/processes about eating disorders for systems, services and individual practice Collaboration and Context Ability to share information locally and continue local professional development Multidisciplinary teams, actual or virtual Referrals pathways are established Protocols support collaborative shared care Consumers with experience of ED are involved in service development and evaluation Within the local service context, not outside it Locally based relationships, services and networks integrated long term care plans Communication PRIMARY C CHECKLIST FOR Mindframe Guidelines Communication about weight and shape, is safe Use of anthropomorphic measurements is appropriate and undertaken by appropriate professionals Prevention and Early Intervention STEPPED CONTINUUM OF C General Outpatient Recovery Support Services Intensive Outpatient Day Program Inpatient Care Goal: Development of community integrated, evidence based approaches to eating disorders in primary care nationally Through: Support to PHNs by providing individually planned and tailored: NEDC PHN CAPACITY BUILDING PROJECT Carer Education and Support Entry level may be anywhere along continuum Flexible step up/down/in/out pathways meet individual need Integration and transition support between treatment Integration and collaboration across health settings Dissemination of information and resources Implementation of evidence based through introductory professional development and workshops Consultation with local services and professionals on their experiences and needs Collaboration with state services, experts and training providers to engage communities and deliver available programs 19 5

6 Key Activities Phase 1: Build relationships Identify needs and opportunities Work together to prepare Champions for change Phase 2: NEDC Members Meeting; PHNs and Primary Care in early 2018 NEDC PHN CAPACITY BUILDING PROJECT Visit us at the exhibitor s hall Contact NEDC Talk within your PHN Join NEDC HOW CAN I PLAY A ROLE? Phase 3: Implementing consistent approaches Support and advice Development of targeted resources and tools based on identified needs