St Vincent’s opens Eating Disorders Outpatient Clinic

28 Sep 2022

The St Vincent’s ‘pop-up’ Eating Disorders multi-disciplinary team have been servicing St Vincent’s inpatients for the past two years, treating people who most often present for other conditions, but are identified as requiring additional support for an eating disorder.

“We estimate that we have one patient every day walking through our doors with an active eating disorder, with only a minority disclosing to clinicians that they have an eating disorder” said Susan Hart, St Vincent’s Eating Disorder Coordinator.

Preliminary data between 2018 - 2020 shows that just 4% of people with an eating disorder are identified at the beginning of their treatment. Of the ones that are admitted, have generally self-identified and are receiving treatment in the community, but have physically deteriorated and need medical intervention.

It’s believed that a quarter of identified patients present for something unrelated to an eating disorder, and another quarter present with mental health concerns, with the remainder presenting with physical side-effects of their eating disorder, such as dizziness, low potassium and volume depletion. They also often present with non-specific symptoms such as abdominal pain.

“While they’re an inpatient we implement a best practise model of care such as regular weighing, and refeeding via a nasogastric tube to achieve medical stability. The “pop up” eating disorder team tries to connect people with the next step of evidence-based treatments in the community. But once the patient is medically stable, they are generally discharged to their GP without always being engaged with such treatment”, explained Susan.

But recent funding from Ministry of Health has seen the commencement of a new dedicated Eating Disorders Outpatient Clinic here on campus.

Staffed by Susan, Rebecca Harrison, Social Worker and Sarah Ghebranious, Dietitian, all have specialised Eating Disorders expertise, and will provide a continuum of care for patients upon discharge, as well as treating people referred from the community.

“We are targeting people in the local area who are falling through the gaps, people who aren’t engaging with dedicated professional help for their disordered eating”, said Rebecca Harrison, St Vincent’s Social Worker.

And people are falling through the gaps for a number of reasons.

“Unfortunately there is stigma associated with eating disorders. There is a challenge with finding mental health clinicians with expertise who will take on an eating disordered patient, partly because of the physical implications of the disorder that come with it”, explains Susan.

In addition, the illness itself can sometimes preclude patients from seeking help.

“Feeling ambivalent, or unsure, about change is part of the illness”, explained Rebecca. “Eating disorders often play a role in managing difficult emotions, anxiety or trauma. For some, the hyper focus on food, weight or exercise can have the effect of narrowing the world into something more familiar and containing. The eating disorder can feel helpful, even essential. So you have this paralysing internal conflict - even when a person is aware it is having a devastating impact, on their health, their relationships - the illness insists that they can’t survive without it."

For some people, dealing with self-conflict while trying to navigate referrals, wait lists and appointments can be overwhelming. Part of the teams’ role is to support people through the process of gaining a GP referral Eating Disorders Plan and staying on the recovery pathway while a clinic placement becomes available. And those who aren’t able to access clinics in the community, can receive treatment here on campus.

But one of the biggest issues however is a missed diagnosis.

“When we think about what eating disorders look like, we often think of young white women, but there are diverse presentations that include people with mental health concerns, and or substance use disorder. They can be older, have multiple health issues, and be from culturally and gender diverse backgrounds”, said Susan.

The good news is that recovery is possible, and an eating disorder is not a lifetime diagnosis.

“We can’t make people eat, but what we can do is work with them on nutrition related goals, like gradually increasing their total intake’, said Sarah Ghebranious, St Vincent’s Dietitian. ‘Or it might be as subtle as getting them to change to a new brand if they’re very rigid about their food choices – so we’re encouraging them to practice flexibility until it becomes more comfortable. Sometimes it’s about accountability and responsibility - just to be seeing somebody to talk about what’s happening. Even if you’re not ready to change anything.

It’s about meeting people where they are”.

For enquiries and/or referrals to St Vincent's Eating Disorders Clinic, ph: 0403 190 090 or email: svhs.eatingdisorders@svha.org.au

Susan Hart 2

Susan Hart, Eating Disorders Coordinator.

* If you would like more information about Eating Disorders or need additional support, you can find resources here or call 1800 33 4673.