Home Eating Disorders Treatment Treatment settings

For most people with eating disorders, their general practitioner is the first point of contact. For some people, where the eating disorder may be diagnosed as ‘mild’, the GP may take the lead in treating the eating disorder.  In treating a patient with an eating disorder, GPs may involve other practitioners such as dietitians and psychologists

Some people access treatment for eating disorders through Community Health Services in Victoria.  The capacity of community health centres to assist people with eating disorders will vary considerably from centre to centre, depending on what sort of services they offer.

For many cases of eating disorders, more specialist treatment is necessary.  This may be in the public or private sector.

In the public health sector in Victoria, adults with eating disorders will generally be referred to adult mental health services (AMHS). From AMHS, depending on the stage of the disorder, they will either be referred to treatment in a community setting, (where the individual may see a psychologist, psychiatrist or counsellor, often along with a dietitian and  back-up medical monitoring)  or be referred  to a specialist eating disorder service at a  hospital.  People with eating disorders may also present directly to the emergency departments of public hospitals.  Individuals are then treated as inpatients, outpatients or daypatients, depending on what is offered at the hospital and the severity of the illness.
 
In the private sector, there are a variety of private hospital psychiatric services and specialist eating disorder inpatient, outpatient and daypatient programs.

There are also some excellent university-run psychiatric programs which offer a range of psychological treatment services; these are fee-paying services but are generally lower cost than private treatment centres.

In the public health system in Victoria, children and adolescents with eating disorders are treated through outpatient clinics run by  Child and Adolescent Mental Health Services (CAMHS), often in association with local paediatric services.   There are also a small number of inpatient beds for children at the Centre for Adolescent Health at the Royal Children’s Hospital, at the Austin Hospital and at Monash Medical Centre.  Each of these hospitals also offers outpatient services.  Finally, there is one day patient program for young people aged 12 -24 in Melbourne.  Sadly there is still no consistency in approach to eating disorder treatment between CAMHS across Victoria.

Hospitalisation may be necessary for some people with eating disorders.  This is either for physical reasons – usually for someone who is undernourished to the point that it is a risk to their physical health or their life – or to enable more intensive psychiatric or psychological treatment. 

There are three main hospital settings:

Inpatient Clinic

Inpatient clinics are provided in hospitals and in some private treatment centres.  Patients are admitted to the treatment centre and receive 24-hour care.  The location of the inpatient care varies from hospital to hospital – there may be a specialist unit with beds for eating disorder patients; more commonly eating disorder patients are treated in beds within psychiatric wards, or other in-patient wards in hospitals.

Patients who are admitted as inpatients are generally acutely medically unwell and have severe symptoms.  Treatment generally focuses first on medical stabilisation, re-feeding and weight restoration.  Ideally, once the patient is medically stable (ie their life is out of danger), some sort of psychotherapy is usually given as well.  However, whether this happens depends on the hospital treatment regime.  When the patient is considered well enough, they are normally moved to a day patient or an outpatient program.

People with Anorexia Nervosa in particular may be admitted to hospital for ‘re-feeding’ and weight stabilisation.  Intravenous drips or a naso-gastric tube may be used (a tube inserted through the nose to the stomach).

Outpatient Clinic

Many people with eating disorders do not need 24-hour care, but they do need ongoing treatment.  These people may attend outpatient units on a regular basis, where they may be seen by a team of health professionals from many different disciplines, or they may see a solo practitioner like a dietician, a psychologist or a psychiatrist.

People are encouraged to maintain everyday responsibilities, like attending school or going to work. Therapy and support is provided to enable that person to deal with the practical and emotional difficulties caused by their eating disorder, but they must ‘go it alone’ for much of the day.

Daypatient Program

For some people, the step from inpatient to outpatient treatment is too great, and these people may benefit from the intermediate level of support provided by a day program.  Victoria has only one day program service. 

Day programs provide a structured day with supervised or supported meals and eating, along with ongoing therapy during the daytime, up to five days a week, while allowing the individual to live at home and benefit from family interaction overnight and at weekends.

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