Rural postcodes affecting access to treatment for eating disorders

Anastasia Tsirtsakis

23/06/2020 3:58:21 PM

A recent survey has highlighted the extent of barriers faced by people outside of the city.

Rural sign post
Almost 95% of rural people surveyed said where they live poses an obstacle to accessing help for an eating disorder.

The MAYDAYS PushingPastPostcodes report found that 94% of those surveyed believe where they live poses an obstacle to getting help, with 34% travelling more than 100 km to receive care.
Cost was also cited as a significant barrier, with 78% of people with an eating disorder going without basic and essential health requirements due to treatment costs.
Dr Tania Jones, a GP in north-east Victoria, said the findings, while concerning, are not surprising.
‘Working in primary health you want to make sure that people can get access, and yet when we look at our books every day we’re fully booked,’ she told newsGP.
‘Also, a lot of general practices in rural Victoria are private clinics – so you can actually entice and recruit GPs to come up to the area, [and] because Medicare with the freeze has fallen behind CPI. You have to have those costs and therefore patients have to take on those costs.
‘So you’ve got the barrier of not being able to get appointments and that barrier of cost in accessing help.’
The survey coincides with the Butterfly Foundation’s national annual campaign, MAYDAYS for Eating Disorders.
Conducted anonymously online, the survey was completed by 563 people, the vast majority of whom identified as female and were aged 18–30. It included individuals who are either currently experiencing an eating disorder or have previously, as well as carers.
Distributed in April amid the COVID-19 pandemic, the findings highlighted that 80% of those with an eating disorder needing extra help during lockdown, and 63% claimed COVID-19 has affected their ability to seek treatment.
While telehealth has been pivotal in GPs continuing to safely deliver care, Dr Jones says it can have limitations, primarily when patients are seeking help for an eating disorder for the first time.
‘You’re talking about patients who are already having a mental health condition that is so secretive, so difficult, so confronting and challenging on their body in so many aspects,’ she said.
‘If you don’t have a pre-existing relationship, it can be really difficult.
‘People presenting with mental health and eating disorders, there’s a lot of body language because it’s often very physical complaints at the beginning, and you can’t see that [over the phone]. So that interaction that you get in face-to-face is lost.
‘You can still invite them in, but you lose that initial contact, and you may not have formed that trust over the phone because of those barriers that can be there.’

Rural GP Dr Tania Jones appreciates telehealth, but said it can have limitations in terms of building trust and seeing patients’ physical cues.

But even when it comes to in-person consultations, 92% of respondents said healthcare workers in rural and remote Australia need more training and education on eating disorders. More than 60% agreed longer consultations would improve the experience of seeking care – a challenge Dr Jones attributes to the current Medicare structure.
‘We’ve still got this set-up of “quick medicine”, and that’s one of the hardest things,’ she said.
‘Usually, as a GP, you have 15-minute appointments if you’re lucky; some only have 10 minutes and some have six. So to cover those things in that time and form that rapport is another stumbling block.
‘Our set-up isn’t perfect for it, but we do encourage for all of our doctors in training to recognise [that] and then invite patients back for a follow-up appointment so that they can explore it further.’
The Federal Government last year introduced 64 new item numbers under the Medicare Benefits Scheme (MBS) giving patients with severe and complex eating-disorder presentations greater access to psychological treatment and a dietitian.
While Dr Jones acknowledges this has been a positive step for patients, she says wait times for rural patients continue to be excessive.
‘Unlike in Melbourne, if you’ve got someone who’s really unwell, you don’t have those major clinics or that quick referral pathway to escalate care. It’s very difficult,’ she said.
‘For a psychologist up our way, you’re looking [at] a minimum of six weeks to get in to see somebody because they’re so heavily booked.
‘You also need to know within your local area for referrals who actually specialises in that area. But with things changing all the time that can make it difficult.’
There are more than 280,000 people living with an eating disorder in rural, remote and very remote communities in Australia.
The delay in getting patients the help they need, Dr Jones said, can be very disheartening for GPs, resulting in feelings of helplessness.  
‘All of our GP media tell GPs, “Do your mental health plan, refer on to these people, get them involved”. So you think, I’m failing this person by not being able to do those things, that we don’t have all those people who are easy to access,’ she said.
‘Over the last few years, in particular with mental health plans really increasing, I had this feeling that I really recognised how difficult it was for me to refer anyone on, and that thought of “I don’t want anyone to come through my door because I’m going to fail you and I know you need lots of help, and I’m not going to be able to”.
‘[Yet] despite those delays in referring on – and the delays are huge – recognising that we still play such a huge part in that person’s recovery journey is something that especially GPs should not be dismissive of.’
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