Eating disorder expert Bronwyn Wood says burden is falling to private practice

Bronwyn Wood, a credentialed eating disorder clinician (CEDC), says the public system is so over-run, "they turn people away before they even get in the door".

People aren't seen, they aren't even assessed and they are "flicked back out to private", she says.

Yet it can be difficult for people to access private psychology services because of cost, lengthy waiting lists, and even the fact some practitioners are seen as having their "books full", according to Ms Wood.

In 2021 alone, she had to turn away 43 referrals for eating disorders, on the back of a rise in the number of cases during and post-pandemic.

"I don't even know where they went," she says.

And that's the heart-breaking part - knowing there's nowhere else for people to turn ... often the only option is telehealth appointments with clinicians in the major cities, Ms Wood explains.

Given the location and size of Albury-Wodonga that's just completely unacceptable, she insists.

"There is no specialist eating disorder clinic, no in-patient or out-patient day programs," she says.

"We don't even have beds allocated here - there is no acute admission.

"There are no beds available and you have to go through the triage process where you are at risk of putting the person's mental health more at risk."

Add to that the challenges of navigating public mental health across state borders and the barriers only increase, Ms Wood adds.

And while there are "layers of people doing things, they are not always inter-linked".

One of the most important steps in offering better support to people with eating disorders is improved networking and a system that enables people to complete professional development in treatment, according to Ms Wood, who is a board approved supervisor.

"Traditionally psychologists are fearful, there is stigma around treating eating disorders," she admits.

"They are seen as scary, 'medical' and 'not our area of expertise'.

"Often it might be a case of one person who is known to have an interest or expertise in this area."

And while it is a positive the new Medicare eating disorder plans provide additional sessions for those with a diagnosis, Ms Wood fears it only worsens the public health situation.

"It is core business but the burden has fallen to private practice," she says.

"We need to accept how common this is and that it is a serious mental health disorder that needs support and expertise."

There should be training across departments rather than be clinician dependent, according to Ms Wood.

It's about building workforce capacity and that takes dollars "but we've been talking about this for year," she laments.

"It's a passion area for me.

"Yes, we need specialists but we also need to encourage people to upskill - from psychologists and psychiatrists to GPs, nurses, and mental health social workers, particularly in public health.

The emergency department has to be an option to seek treatment, she insists.

"It's not just about hydration or re-feeding; it's about training in all levels of care."

Sadly, one of the biggest challenges still lies with "embedding" an understanding of eating disorders in the health sector.

There's still stigma and even weight bias, Ms Wood reveals.

Terrifyingly, she says, sometimes the behaviour is praised (she attributes that to our relentless "diet culture").

"It needs to be seen as real with significant psychological and medical risk," she says.

Ms Wood has also previously provided input and feedback to Albury-Wodonga Health to update its policies and procedures for a "safe admission".

"But we are definitely not there yet," she admits.

Ms Wood, who has worked in this space for more than 10 years, says the bulk of her clients are adults with eating disorders, although she does have clients who are 16 and 17 years of age.

Generally patients come in under a general mental health plan but she also sees patients under the new Medicare Better Access initiative (which provides rebates for up to 40 sessions of evidence-based psychological treatments).

Cost still presents barriers, she explains.

"In one way it's good - I see a lot of people who have these plans - but for many the gap fee is unaffordable.

"And it takes away the burden where it needs to be - on the public health system!"

The bottom line is the Border and North East does not have the option of the type of stepped care that's needed.

After a person has been restored in terms of nutrition and weight, that's just the first step in recovery and there are gaps in the continuity of care, Ms Wood says.

"We do not have services in place that can help and respond to support recovery from an eating disorder," she states.

"And we can't have admissions in Sydney or Geelong for them to be flicked back to where exactly?"