A lack of qualified specialists and publicly-funded dedicated services have left Tasmanian adults living with an eating disorder without access to treatment, says a senior Tasmanian Health Service employee.
The employee, who has intimate knowledge about services in Tasmania and who asked to not to be named for fear of losing their job, said despite their prevalence and the fact eating disorders have the highest mortality rate of any mental illness, Tasmania has no specialist services for adults.
"We don't have a publicly-funded inpatient program, we don't have a publicly-funded day program and we don't have a specialist service of clinicians who are specifically credentialed to work with patients with eating disorders," they said.
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"We need to be able to offer all levels of care and all intensities of treatment to patients with eating disorders because they are at a very big risk medically, psychologically and psychosocially.
"Once [eating disorders] become a long term problem they can lead to other co-morbid mental health problems ... which can further increase the burden on quality of life."
A Department of Health spokesman said at present care was provided through other services. "Adults living with eating disorders access treatment through primary healthcare providers including GPs, psychologists, counsellors and dietitians," the spokesman said.
The Butterfly Foundation estimates 21,000 Tasmanians are living with an eating disorder.
But when it comes to our young adult and adult population the services that are available seem to be conducted in the private sectorSenior THS employee
Tasmania does have a public service for adults who need treatment for mental illnesses but the employee said patients with eating disorders appear to be underrepresented in that system.
"It seems to be the case that we have a reasonably supportive structure in place to help children and adolescents with eating disorders, which makes sense because often eating disorders develop during those years," they said.
"But when it comes to our young adult and adult population the services that are available seem to be conducted in the private sector.
"There is service available in the public sector but it is not a specialised team and that is where things get difficult for patients ... you need a multidisciplinary team and you need a very co-ordinated specialised approach."
InsideOut Institute for eating disorders at the University of Sydney, Australia's first institute for research in eating disorders and clinical excellence, director Dr Sarah Maguire said access to specialist services in Tasmania has been a longstanding issue.
We are seeing a federal shift in the service response for eating disorders and some of the smaller states are a way behind, Tasmania is one of thoseDr Sarah Maguire
She said Tasmania is lagging behind other states in Australia.
"In the last five to 10 years we have seen a lot of advancement in NSW, Victoria and South Australia and Queensland all have been developing services for quite some time," Dr Maguire said.
"We are seeing a federal shift in the service response for eating disorders and some of the smaller states are a way behind, Tasmania is one of those."
Tammy Rowlings' daughter, 17, is being treatment for an eating disorder at the Child and Adolescent Mental Health Service.
CAMHS is good ... but where to from here? Where do you go when they hit that 18 ... and they say you are no longer connected to these servicesTammy Rowlings
CAMHS provides a multidisciplinary approach which Ms Rowlings said had been helpful, but she worries what will happen when her daughter turns 18.
"When she turns 18, that is the biggest concern, I said to my husband, 'because she is 18 next September, let's get her better by then' or we have got to find another way forward," Ms Rowlings said.
"CAMHS is good ... but where to from here? Where do you go when they hit that 18 ... and they say you are no longer connected to these services."
A Department of Health spokesman said young people transitioning to adult services commence a plan six months before turning 18.
"A working group of senior clinical staff including a senior psychiatrist, social work, psychology, occupational therapy and medical representation from the Launceston General Hospital has been established to develop a pathway for people needing mental health services for eating disorders," the spokesman said.
He said since 2014, $104 million had been invested into improving mental health services but did not specify how much of that went to help address people with eating disorders.
The problem isn't just a lack of publicly available specialist services, there is also a lack of qualified private physicians, according to Dr Maguire. She said treating eating disorders is a complex and evolving field which requires clinicians to stay up to date with the best techniques.
"It is a problem all over the country, identifying appropriately trained health professionals who have enough expertise in eating disorders to provide the evidence-based treatments in the communities," she said.
"When you get to places where the population is lower it is really just a critical mass issue, getting access to those sorts of health professionals with that sort of skill set is really hard and that is an issue for Tasmania, it is an issue for a lot of places in Australia.
"The federal government has funded 5000 places across Australia in online training in eating disorders for any health professional who is going to be providing care under medicare or through the public system ... that has just begun to be rolled out through the InsideOut Institute."
Ms Rowlings has experienced the lack of options first hand.
She has been trying to find private services for her daughter, to prepare for when she turns 18, with no luck.
Getting access to those sorts of health professionals with that sort of skill set is really hard and that is an issue for Tasmania, it is an issue for a lot of places in AustraliaDr Sarah Maguire
But after contacting several psychologists in the Launceston area she was unable to find one who could help.
Georgina Taskunas is the Butterfly Foundation's eating disorders co-ordinator in Tasmania.
It is her job to connect people looking for care with the relevant services.
She confirmed the frustrations about a lack of specialised services and qualified specialists.
Butterfly Foundation runs a recovery support service for people living with eating disorders and their carers in Hobart.
The program was launched last year after a $400,000 commitment from the state government.
But Ms Taskunas said the foundation does not offer clinical services in Tasmania, unlike in some other states.
She said access to some services was improving thanks to federally-funded Medicare item numbers which were brought in last year and the funding from the state government.
The item numbers allow people diagnosed with eating disorders to access up to 40 sessions with a suitable mental health professional and up to 20 sessions with a dietitian per year.
But the problem is not enough health professionals specialise in eating disorders and not everyone can afford private care.
"There is hope, it is not all bad but there definitely isn't enough in Tasmania," Ms Taskunas said.
"Prior to COVID-19 we had organised Eating Disorder Victoria to come down and we were doing a training day for GPs in Hobart and Launceston. Fingers crossed we can get it done later this year."
In 2019, the federal government announced $10 million would be spent building a residential eating disorder centre in Hobart.
The centre will provide specialist care and improve the way eating disorders are diagnosed and treated through training education and advocacy. No timeline was given for when the centre would be completed.
- If you or anyone you know is experiencing an eating disorder or body image concern we encourage you to reach out for support: Butterfly Foundation National Helpline, 1800 33 4673.
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