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Q. As a GP with a special interest in this space, what are the major gaps in the WA health system in regard to eating disorder services and accessibility?

SC: Unfortunately, the gaps are at all levels in the health system – both private and public, and in primary and tertiary-level care.

There is a six-month wait list for private and public psychological intervention, and often more than six months for a Psychiatry review.

In addition there are waitlists for private hospital beds, and a public system in both child and adult care that does not have adequate inpatient beds or a dedicated service that reflects the medical and psychiatric nature of the illness.

The primary care sector is equally deficient, with the few GPs who have a special interest in the area no longer taking new patients and the majority of GPs lacking education and experience. I believe that many GPs would be willing and able to manage eating disorder patients but require support to increase confidence. I don’t believe there is enough education among medical students, junior doctors or GP registars to reflect the importance of this condition. If we could start with educating students to be competent and aware of presentations and follow up with a more comprehensive unit for GP registrars, we would find more doctors recognising eating disorders and seeking appropriate management.

Although Medicare has introduced item numbers that make the intensive psychological/dietetic support more accessible, there is not the trained staff to provide the service in a timely manner.

Even for those GPs who recognise and refer onwards, there will be a significant wait time before services are available and GPs can be left holding patients for many months without the skills to provide initial interventions that may halt the progress of the eating disorder.

I really hope to see both the tertiary service fully equipped and primary care capable of managing patients in a way that reduces the need for hospitalisation.

Q. Are there particular areas, such as the transition from adolescent to adult care, that are particularly challenging to manage? In the above cited example, how can we prevent patients from falling through the gaps?

SC: The more chronic and complex eating disorder patients who have had multiple admissions to hospital are very challenging to manage, as they require intensive support and and may not have achieved recovery with traditional evidence-based treatment programs. We are left with little evidence base for their recovery and as a GP, can be left without tertiary support for long-term management.

As a GP, I am of the belief that good communication and collaboration is the most important protective factor in managing the transition from child and adolescent services to adult care. GPs are in a privileged position to see patents across their entire journey but need to feel supported by tertiary care to safely manage more complex patients

Q. With the Federal Government announcement of the Australian Eating Disorder Research and Translation Strategy, do you believe eating disorders is finally getting the acknowledgement it deserves as a serious, complex disease with a recovery rate of only 60-80 per cent?

SC: I am hoping eating disorders has finally achieved the recognition it deserves as a serious and complex illness. With the promise of funding, we must keep in mind the current research that suggests the importance of early intervention and that we recognise the far-reaching consequences that prolonged illness has on individuals, families, communities and loss of potential.

There must be a balance between caring for the more complex cases that require hospital admission, minimising trauma associated with hospitalisation, while also prioritising early intervention strategies. Supporting research that will help us identify environmental triggers and protective factors and providing education to clinicians should be a priority with the allocation of funding.