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Streamlining referral and management pathways for eating disorders

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‘We really want to help GPs in this space. Because of both the physical and psychological consequences of eating disorders, they’re not straightforward patients.’
 
That is Jodie Ashworth, Executive Director at Wandi Nerida, Australia’s first dedicated residential eating disorder recovery facility operated by the Butterfly Foundation.
 
The facility, set on a 25-acre property on Queensland’s Sunshine Coast, has finalised its first intake of participants from some 100 GP referrals and is set to open this month.
 
According to Ms Ashworth, GPs bookend the multidisciplinary team that cares for patients with eating disorders, with one of the centre’s aims to streamline the referral pathway.
 
After the patient is assessed and meets the Wandi Nerida admission criteria, the triage team will discuss the patient’s goals with the GP and create a care plan. Once admitted, residents will stay for an average of 60 days and receive care from the multidisciplinary team.
 
‘The model is set up so there are psychiatrists and a physician that specialises in eating disorders,’ Ms Ashworth said.
 
‘We’re hoping that the physician will also be able to network and mentor the GPs … in recognition of their role in the model of care.’
 
Once discharged, patients receive follow-up care from their GP.
 
Dr Elizabeth Crouch, a GP with a special interest in eating disorders, told newsGP she is ‘very excited’ about Australia’s first residential treatment facility. She understands how important the referral pathway is for people with eating disorders, particularly upon hospital discharge.
 
‘There are many barriers, including wait times, difficulty coordinating services and very significant costs,’ Dr Crouch said.
 
‘Given the tenacious nature of eating disorders, there is no simple treatment pathway and often people need to try different models of care to have successful treatment. 
 
‘Having a residential facility streamlines the process and allows the patient to have as much support as they need.
 
‘In the community the impetus of treatment can be lost due to the inability to see the treating practitioners often enough. [For example,] the dietitian, psychologist, psychiatrist may only schedule appointments every 2−4 weeks or longer, so it can be difficult to have the ability to modify treatment quickly.’
 
Current treatment for eating disorders involves either:
 

• outpatient care through private practitioners who require individual referral, such as a psychiatrist and/or psychologist, dietitian, family therapist 
• inpatient care through a small number of private hospitals 
• public services such as outpatient and restricted inpatient services for anyone aged over 18.

 
While she acknowledges hospitals ‘save lives’ of people with eating disorders, Ms Ashworth believes the length of stay does not always allow the ‘intense psychological assessment’ required to maintain the trajectory for recovery.
 
That’s where Wandi Nerida comes in.
 
The facility has been built to resemble a home − the intention of the residential model − to connect and help patients in transition from the acute hospital environment.
 
‘It is set up to continue that intense psychological program and change lives by offering a long stay, to address many of those issues with connection that these clients have,’ Ms Ashworth said.
 
‘And let’s be clear, it’s not just the connection with food; it’s a connection with self, a connection with family, a connection with so many other body image things. Food is just a very small part of it.’

When GPs are involved in discharge planning and have clear pathways about ongoing management, it improves knowledge and gives more confidence, according to Dr Elizabeth Crouch.

Wandi Nerida is a licensed level 4 private mental health facility. The electronic referral pathway integrates directly into the centre’s medical records, streamlining the process for the patient and their GP.
 
Once the 60-day stay is complete, GPs are an ‘integral part’ of the transition back into the community.
 
‘With the discharge plan, everyone is clear as to what that looks like,’ Ms Ashworth said. ‘We contact the GPs on a monthly basis to let them know how their patients are going while they’re admitted at Wandi Nerida.
 
‘Then, prior to discharge, we are hoping to engage them in a multidisciplinary team discharge meeting via telehealth. This gives us an opportunity to engage GPs in the care prior to discharge rather than just pushing out a letter.
 
‘And [it’s] helping our GPs have the skills and capability to manage these clients, because they are complex, they are challenging and they are difficult to manage.’
 
Dr Crouch agrees.
 
‘GPs are integral to ongoing support following discharge and being involved with the team is very important to ensure that the patient and GP have clear messages and clinical guidelines about maintaining gains made during their stay,’ she said.
 
‘It is very satisfying as a GP to be able to be involved in the care of our patients through difficult times and strengthens the therapeutic relationship.’
 
Australia has recently seen a rise in pandemic-related mental health issues among younger people, including more frequent presentations of eating disorders.
 
Dr Crouch believes GPs would be equipped to provide ‘better and more frequent’ care to patients with eating disorders with more support from psychiatrists, psychologists and dietitians.
 
‘The model of residential facilities with GP liaison would definitely help with this,’ she said.
 
‘I have seen many patients who have had residential care in other countries and have been impressed with how effective it has been for complete recovery at a fraction of the time and cost compared to outpatient facilities.’
 
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eating disorders mental health referral pathways

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