NEDC e-Bulletin

 In our weight-conscious society, we sometimes forget that the whole world doesn't see the body the way we do (Becker, 1995).

Editor’s Note

Last week, across the country, we came together to acknowledge National Reconciliation Week and the cultural journey that we are on as a nation. Given the importance of this time, it is noteworthy to consider how culture influences our interpretation of illness, body image and overall health and wellbeing. 

In this edition, we examine the concept of culture and the influence of culture on the diagnosis of an eating disorder. We look at how the influence of culture impacts the individual when seeking help, and the delivery of best practice eating disorder management.

We know that eating disorder management requires quality care, provided through a multidisciplinary team; But - what does this look like when the individual may bring a unique interpretation of illness and treatment, guided by their cultural influences? 

In particular, we discuss eating disorder identification, prevalence and management with health professionals providing mental health support services to Aboriginal and Torres Strait Islander communities, and we look at the importance of understanding Aboriginal health in the context of Social and Emotional Wellbeing. 

National Reconciliation Week calls on all Australians, to understand, value and respect each other. To improve outcomes for all Australians living with an eating disorder, it is imperative that an integrated, multidisciplinary approach is also culturally appropriate.

The NEDC acknowledges the lack of evidence in this space and that further research is needed to foster greater knowledge about the delivery of best practice, eating disorder treatment and management that is holistic and encompassing of the social and emotional wellbeing of Aboriginal people.

This is an important subject to address, and the NEDC wish to thank and acknowledge all those that have contributed to this e-Bulletin by providing their knowledge and expertise within this area of work. In particular, NEDC want to thank, BOAB Mental Health Services, The National Aboriginal Community Controlled Health Organisation (NACCHO), Doctor Laura Hart, of the University of Melbourne, Doctor Elizabeth Dale, Clinical Psychologist and PhD Indigenous Researcher at the University of Wollongong and Professor Phillipa Hay, Chair of Mental Health, School of Medicine at Western Sydney University.

Contents

1. Feature: Culture and its Influence on Eating Disorder Identification and Management.
2. Q and A – Eating Disorders in Aboriginal and Torres Strait Islander Peoples
3. Aboriginal Social Emotional Wellbeing and Eating Disorder Management
4. Around the Sector: News, Training and Professional Development.

1     Culture and its Influence on Eating Disorder Identification and Management

Nearly half (49%) of Australians are either born overseas (first generation Australian) or have one or both parents born overseas (second generation Australian). In Australian homes, 300 separately identified languages are spoken, and more than one-fifth (21%) of Australians speak a language other than English at home  (Australian Bureau of Statistics, 2017).

Additionally, 649,200 people reported being of Aboriginal or Torres Strait Islander origin. One in ten Aboriginal and Torres Strait Islander people reported speaking an Aboriginal language at home, with 150 Aboriginal dialects being spoken in homes across Australia, reflecting the linguistic diversity of Australia’s Aboriginal and Torres Strait Islander people. (Australian Bureau of Statistics, 2017).

What we know is that we are a culturally diverse nation. We are home to the world’s oldest continuous cultures, as well as Australians who identify with more than 270 ancestries (Australian Human Rights Commission, 2015). It is fair to say that our understanding of ‘culture’ underpins many elements of our everyday interactions.

How does this diversity shape the society in which we live? How does this shape our understanding of health and body image? 

Sociocultural factors have long been implicated in body image and eating disorders (E. Anderson-Fye, 2017). Hence, it is essential to consider how culture influences disordered eating behaviours, eating disorder management and recovery.

Research suggests that culture has three components (E. P. Anderson-Fye, 2017). Firstly, it has a meaning-based component, derived from ideas, ideals and beliefs. Secondly, it has a behavioural component reflected in actions, rituals and habits. Finally, this combination of meaning and behaviour is shared by a united social group.  Ultimately, culture is best understood as a dynamic, ever-changing, construction that emerges from interactions between individuals, communities, larger ideologies and institutional practices (Furler & Kokanovic, 2010).

Culture is often considered an aspect of identity and experience (Furler & Kokanovic, 2010) and as a variable of belonging to a racial or ethnic group (E. Anderson-Fye, 2017). Within a culture, we observe an interaction of elements that are unique within their associated group. This interaction of factors influences our understanding of health and wellbeing (Pate, Pumariega, Hester, 1999) and how we perceive illness or define symptoms as ‘normal’ or ‘abnormal’. It also defines our understanding of the cause of an illness (Furler & Kokanovic, 2010).

Eating disorders across cultures: cultural factors and their influence on the experience of illness

Cross-Cultural measurement of eating disorders is difficult given the wide variation in cultural values, practices and norms concerning food and body experience (Becker, 2007).

Body shape and ideals worldwide are diverse. Signs and symptoms of an eating disorder can appear to be of no importance to some cultural groups, despite their clinical significance. The gap between the western diagnostic interpretation and any given cultural diagnostic interpretation means that an eating disorder may go undiagnosed. In some cultural settings, the diagnostic signs and symptoms of an eating disorder appear to be of no cultural importance, despite their clinical significance. As a result of this, individuals are less likely to seek help or accept treatment for an illness that is not culturally recognised  (Becker, 2007).  

Cross-cultural presentations of eating disorders

Existing research has described cultural variations in characteristics of disordered eating behaviours with a number of cultural differences identified. A study of Hong Kong Chinese groups identified an absence of ‘Fat Phobia’ amongst individuals who otherwise appear to meet diagnostic criteria for anorexia nervosa. Similar findings were evidenced amongst groups in Japan, Malaysia, Singapore, and India (Sing Lee, 1994). This research also found that within eating disorder presentations in India, body image disturbances differed from the characteristics of the DSM-V definition for anorexia nervosa.

In Fiji, where culturally sanctioned feasting is routine, herbal preparations are commonly used as purgatives to compensate for the feasting behaviour. What is more, dieting and purging behaviours experienced among Fijian females are related to wage-earning potential, as being slim is seen to enhance your social and economic opportunities (Becker, 1995). These disordered eating behaviours are comparable to western diagnostic criteria; however, as there is no local, cultural correlation of these behaviours with an eating disorder, these symptoms are not experienced as illness (Becker, 1995).

The social influence of culture

The influence of culture on the signs and symptoms of an eating disorder are reflected in varying ways throughout society. An individual’s rationale for food refusal, concern with body shape and distress associated with overeating will vary with the value that a culture places on body image and dietary norms (S. Lee, Ho, & Hsu, 1993).

Social expectations and the physical environment within a cultural setting will shape and limit symptom presentation. For example, differences in signs and symptoms may exist in lifestyles that provide opportunities for privacy and an abundance of food resources that are not afforded by other social environments (Becker, 2007).  Variations in cultural setting also influence the individual meaning of symptoms; this contributes to an altered response to help-seeking and treatment (Becker, 2007).

The diverse social norms reflected throughout different cultures will influence whether an individual will disclose disordered eating behaviours and seek help (Becker, Hadley Arrindell, Perloe, Fay, & Striegel-Moore, 2010). The social stigma associated with an eating disorder may prevent an individual from initiating help-seeking behaviour, with the social cost of disclosure judged to be too substantial if the eating disorder is deemed to be associated with status loss and discrimination within a cultural group (Becker et al., 2010).

Additional elements of culture, such as the role of family and community, and verbal and nonverbal communication, differ across cultural groups. An individual’s understanding of mental and physical health exists within their unique cultural framework. Interpretation of the cultural norms of community is essential when identifying symptoms of illness (Hart, Jorm, Kanowski, Kelly, & Langlands, 2009). 

Importantly, the influence of culture is not only evidenced in help-seeking behaviour and our ability to identify an eating disorder, but also in determining how an individual will access help, support and health services.

How does culture influence eating disorder management and treatment?

Beyond language, different values, beliefs, and preferences have an important effect on the management of patient care (Furler & Kokanovic, 2010).

Almost one-third of the Australian community identify as having culturally and linguistically diverse backgrounds, highlighting the significant diversity in social, educational and economic settings that exist within our society (Australian Bureau of Statistics, 2007).

We know that Australians from different cultural backgrounds experience barriers to health service usage within Australia (Australian Bureau of Statistics, 2007).  A longitudinal study found that when immigrant groups from non-English speaking countries had been in Australia for more than ten years, their mental health and self-assessed health were worse than that for Australian-born individuals (Jatrana, Richardson, & Pasupuleti, 2018). 

The influence of culture is significant for both the health professional and the patient, both positively and negatively. Culture can influence when and how an individual will seek help, and their expectation of what that help might look like, and cultural factors influence the health professional’s response to a patient. Health professionals have their own culture that shapes their expectations of patient management; defining their understanding of the patient relationship along with how clinical decisions are made and managed (Furler & Kokanovic, 2010). As a result, stereotyping and potential clinical biases can hinder the recognition and detection of eating disorder symptoms (Becker et al., 2010).

What barriers exist to receiving best practice eating disorder treatment and management?

Research suggests that the successful delivery of health care in a multicultural setting may be hampered by factors including, nonverbal communication barriers between the health professional and the patient and a lack of awareness of cultural traditions and beliefs in the practitioner-client relationship (Renzaho, Romios, Crock, & Sonderlund, 2013).

The Australian Institute of Families Studies (2008), divides the barriers experienced by individuals from diverse groups into three categories. These barriers are illustrated in the diagram below.

Additionally, Hart, Jorm, & Paxton (2012), suggest that for cultural minority groups within Australia these barriers, along with poor mental health literacy, significantly contribute to the delay in uptake of health services amongst these groups.

Furler and Kokanovic (2010), identified that for the majority of non-English speaking Australians, consultation is commonly sought through health professionals that practice primarily in English. These health professionals often experience barriers in patient management that involve language and communication, such as poor access to bilingual allied health services and a lack of translated patient educational materials (Furler & Kokanovic, 2010). These barriers alter how an individual experiencing disorder eating behaviours might engage with a service provider or trusted health professional in accessing treatment to support recovery.

Cultural awareness in eating disorder management: cultural competency

Australia, and many other countries, now recognise the influence of culture in the identification, treatment and prevention of mental illness; Across the healthcare system, cultural competency in service delivery and specialised cultural adaptions of health programs are being implemented (Johnstone & Kanitsaki, 2007; Whaley & Longoria, 2008). However, there remains a need to understand and recognise cultural diversity in the presentation of eating disorders so that all those in need of treatment are visible in the clinical setting (Becker, 2007).

Although there is no specific guide to providing a culturally safe and appropriate approach to eating disorder management, there exists a broader approach to providing culturally competent mental health first aid, which can be applied within this setting. Mental Health First Aid Australia (Mental Health First Aid Australia and beyondblue, 2008) outline a culturally competent approach to Mental Health First Aid as:

• Being aware that a person’s culture will shape how they understand health and ill-health
• Learning about the specific cultural beliefs that surround mental illness in the person’s community
• Learning how mental illness is described in the person’s community (knowing what words and ideas are used to talk about the symptoms or behaviours)
• Being aware of what concepts, behaviours or language are taboo (knowing what might cause shame)

A culturally competent health professional has the knowledge and skill to provide a service that is understanding of the significance of a patient’s social and cultural influences on their health beliefs and behaviours. To consider how these factors interact across the health care system and to provide a treatment plan that addresses these issues to assure quality health care delivery (Betancourt, Green, Carrillo, & Ii, 2003).

Resources: cultural competency

When examining cultural competency within the Australian health care sector, several resources have been produced to support professionals with cultural competency in the clinical environment.  A list of these resources are provided below and are available online.

* Cultural Considerations and Communications Techniques: Guidelines to Providing Mental Health First Aid to an Aboriginal and Torres Strait Islander person.
* Curtain University Indigenous Cultural Competency: Cultural Competency

* The Centre for Culture, Ethnicity and Health: A Framework for Cultural Competence
* The Centre for Culture, Ethnicity and Health: Additional Cultural Competency Resources.

* Mental Health in Multicultural Australia: Framework for Mental Health in Multicultural Australia - Towards culturally inclusive service delivery.

* The Australian Institute of Family Studies: Enhancing family and relationship service accessibility and delivery to culturally and linguistically diverse families in Australia resource sheet.

* The NEDC’s Eating Disorders in Australia Fact Sheet is now available in the languages of Vietnamese, Chinese (Simplified and Traditional), Arabic, Russian and Spanish. This fact sheet is accessible to download and print from the Research and Resources section of the NEDC website.

Where to now? Culturally appropriate eating disorder care

There exists little research into the prevalence and identification of eating disorders in Aboriginal and Torres Strait Islander and culturally and linguistically diverse groups within Australia. Ongoing research will provide a greater understanding of the best-practice, culturally appropriate and acceptable treatments for individuals with eating disorders from diverse cultural backgrounds.

The NEDC acknowledges the urgency of incorporating the development of culturally appropriate guidelines for service delivery in the management and treatment of eating disorders. This includes, and has as a priority guideline for the care of Aboriginal and Torres Strait Islander people with an eating disorder. As a collaboration, we are developing our understanding in this area with work currently being undertaken through Flinders University in South Australia, The Centre for Mental Health, Melbourne School of Population and Global Health and Western Sydney University.

In the near future, the NEDC seeks to establish a cultural diversity working group, to engage and consult with health professionals and specialists working within the health and eating disorder sector. Through ongoing research and engagement with professionals working within culturally diverse groups, we look to build a sector that is culturally aware, to provide all individuals living with an eating disorder safe access to a culturally appropriate, best practice, continuum of care.

References

Anderson-Fye, E. (2017). Cultural Influences on Body Image and Eating Disorders. (W. S. Agras & A. Robinson, Eds.) (Vol. 1). Oxford University Press.
Australian Bureau of Statistics. (2017). Cultural Diversity Data Summary. Canberra: Australian Commonwealth Government. https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Cultural%20Diversity%20Article~60
Australian Bureau of Statistics. (2007). Migration Australia (Cat. No. 3412.0). Canberra: Australian Commonwealth Government.
Australian Bureau of Statistics. (2017). Census: Aboriginal and Torres Strait Islander population. Canberra: Australian Commonwealth Government.  https://www.abs.gov.au/Aboriginal-and-Torres-Strait-Islander-Peoples
Australian Bureau of Statistics. (2007). National Survey of Mental Health and Wellbeing. Canberra: Australian Commonwealth Government.
Australian Human Rights Commission. (2015). Face the facts: Cultural Diversity, Australian Human Rights Commission. Sydney, Australia. https://www.humanrights.gov.au/our-work/education/face-facts-cultural-diversity 
Australian Institute of Family Studies. (2008). Enhancing family and relationship service accessibility and delivery to culturally and linguistically diverse families in Australia. Victoria: Australian Commonwealth Government. https://aifs.gov.au/cfca/publications/enhancing-family-and-relationship-service-accessibility-and/resource-sheet
Becker, Anne E.  (1995).  Body, self, and society: the view from Fiji.  Philadelphia: University of Pennsylvania Press
Becker, A. E. (2007). Culture and Eating Disorders Classification. International Journal of Eating Disorders.
Becker, A. E., Hadley Arrindell, A., Perloe, A., Fay, K., & Striegel-Moore, R. H. (2010). A qualitative study of perceived social barriers to care for eating disorders: Perspectives from ethnically diverse health care consumers. International Journal of Eating Disorders, 43(7), 633–647.
Betancourt JR(1), Green AR, Carrillo JE, A.-F. O. 2nd. (2003). Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care. Association of Schools of Public Health. Boston, MA 02114, USA.: Institute for Health Policy, Massachusetts General Hospital and Department of Medicine, Harvard Medical School.
Furler, J., & Kokanovic, R. (2010). Mental health - cultural competence. Australian Family Physician, 39(4), 206–208.
Hart, L. M., Jorm, A. F., Kanowski, L. G., Kelly, C. M., & Langlands, R. L. (2009). Mental health first aid for Indigenous Australians: Using Delphi consensus studies to develop guidelines for culturally appropriate responses to mental health problems. BMC Psychiatry, 9, 1–12.
Hart, L. M., Jorm, A. F., & Paxton, S. J. (2012). Mental health first aid for eating disorders : pilot evaluation of a training program for the public.
Jatrana, S., Richardson, K., & Pasupuleti, S. S. R. (2018). Investigating the Dynamics of Migration and Health in Australia: A Longitudinal Study. European Journal of Population, 34(4), 519–565.
Jennifer E. Pate, Andres J. Pumariega, Colleen Hester, D. M. G. (1999). Cross-Cultural Patterns in Eating Disorders: A Review. Journal of the American Academy of Child & Adolescent Psychiatry, 31(5), 802–809.
Johnstone, M.J., & Kanitsaki, O. (2007). An Exploration of the Notion and Nature of the Construct of Cultural Safety and Its Applicability to the Australian Health Care Context. Journal of Transcultural Nursing, 18(3), 247–256.
Lee, S., Ho, T. P., & Hsu, L. K. G. (1993). Fat phobic and non-fat phobic anorexia nervosa: a comparative study of 70 Chinese patients in Hong Kong. Psychological Medicine, 23(4), 999–1017.
Lee, Sing. (1994). The Diagnostic Interview Schedule and Anorexia Nervosa in Hong Kong. Archives of General Psychiatry, 51(3), 251. https://doi.org/10.1001/archpsyc.1994.03950030087010
Mental Health First Aid Australia and beyondblue. (2008). Mental Health First Aid Australia. Cultural Considerations and Communication Techniques : Guidelines for providing Mental Health First Aid to an Aboriginal or Torres Strait Islander Person. Melbourne: The National Depression Initiative.
Renzaho, A. M. N., Romios, P., Crock, C., & Sonderlund, A. L. (2013). The effectiveness of cultural competence programs in ethnic minority patient-centered health care--a systematic review of the literature. International Journal for Quality in Health Care, 25(3), 261–269.
Whaley, A. L., & Longoria, R. A. (2008). Assessing cultural competence readiness in community mental health centers: A multidimensional scaling analysis. Psychological Services, 5(2), 169–183.

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2.  Questions and Answers about Eating Disorders in Aboriginal and Torres Strait Islander Peoples: Discussing Identification, Treatment and Management

With the lack of research available on eating disorders in Aboriginal and Torres Strait Islander groups, the NEDC recently discussed the topics of prevalence and best practice management of eating disorders with stakeholder groups working in the areas of Aboriginal Mental Health and within the research area.

Speaking briefly with the NEDC, Elizabeth Dale, Masters of Clinical Psychology, PhD Candidate and Indigenous Researcher at the School of Psychology, University of Wollongong, NSW, Australia, answered the following questions.

What is your understanding of eating disorder management amongst Aboriginal and Torres Strait Islander groups?

At this moment in time, there is not enough research to provide a thorough understanding of eating disorders or current treatment efficacy in the Aboriginal context. Additionally, current treatments do not operate according to the Aboriginal worldviews on health and wellness. Along with the lack of research in this area, there are very few Aboriginal psychologists practising across Australia, and for those that are currently in training, they will be trained to practice according to western psychological models, with even fewer specialising in eating disorder treatment.

Additionally, the majority of practice models fail to incorporate indigenous knowledge's or healing practices and have limited empirical support for use with Aboriginal populations due to research methodologies that do not identify or report on Indigenous people correctly.

How can we improve our understanding of best practice management in this space?

Future research is needed to understand better, eating disorders in the Aboriginal context, and this will only come by working in collaboration with communities, Aboriginal community controlled health organisations and using Indigenous research methodologies. This research will hopefully lead to more culturally appropriate interventions and best practice clinical guidelines.

In attempting to exploring eating disorders within Aboriginal and Torres Strait Islander communities further, the NEDC spoke with Josie MacCormak, Mental Health Manager of BOAB Mental Health Services. Boab Health Services is a not-for-profit accredited primary health care organisation providing services and programs to towns and communities across the Kimberley region of Western Australia. Commentary has been provided by the BOAB Team, working as Dietitians and Mental Health Professionals in the West and East Kimberly regions.

We asked BOAB about the prevalence and management of eating disorders within aboriginal communities as they know it. BOAB provided great insight into the complexities of managing eating disorders in remote locations. Read the Q and A with BOAB Mental Health Services here.

We thank both BOAB for their contribution to our e-Bulletin and discussion on this topic.

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3. Aboriginal Social Emotional Wellbeing and Eating Disorder Management

Although there is limited data available on eating disorders within Aboriginal groups, current research suggests that the problems of subjective and objective binge eating are at least as common, if not more common (Hay & Carriage, 2012). This research highlights that eating disorders are as much of a problem for Aboriginal and Torres Strait Islander peoples. However, the way by which we manage the identification of, treatment for and recovery from an eating disorder must differ.

In reviewing eating disorder management within Aboriginal and Torres Strait Islander communities, it is essential to recognise that a difference exists in the understanding of health and wellness for aboriginal people. Perceptions of health among Aboriginal Australians are influenced by their historical experiences and relationships between cultural identity, kinship and land (Dudgeon, Walker, & Walker, 2015).

In 1989, the National Aboriginal and Islander Health Organisation defined “Aboriginal health” as not only the physical well-being of an individual but as referring to the social, emotional and cultural well-being of the whole community. It is a whole-of-life view that includes the cyclical concept of life-death-life. In this holistic interpretation of health, each person can achieve their full potential as a human being, thereby bringing about the total well-being of their community (National Aboriginal Health Strategy Working Party, 1989).

Central to this holistic definition is the concept of social and emotional wellbeing. This concept, as defined by The National Mental Health Commission (2013), describes a positive state of mental health and happiness associated with a strong and sustaining cultural identity, community, and family life that provides a source of strength against adversity, poverty, neglect, and other life challenges.

The Social Emotional Wellbeing (SEWB) Framework

Aboriginal Psychologists developed the Social Emotional Wellbeing (SEWB) framework that defines seven key domains that contribute to this holistic concept (Gee, Dudgeon, Schultz, Hart, & Kelly, 2014).

The diagram below illustrates the concept of Social and Emotional Wellbeing from an Aboriginal and Torres Strait Islanders’ Perspective. Illustrating that self is inseparable from, and embedded within family and community (Gee et al., 2014).

* This image was produced by Tristan Schultz, from RelativeCreative (Gee et al., 2014).

Connection, is key, as illustrated in the SEWB framework. The term refers to the many ways people experience and express the domains of SEWB throughout their lives (Gee et al., 2014). In developing the SEWB framework, it was identified that it is normal for a person to experience healthy connections and a sense of resilience in some domains while experiencing difficulty and/or the need for healing in others. In addition, the nature of these connections will vary across the individual’s lifespan according to their needs, e.g. childhood, youth, adulthood and old age. Importantly, disrupting these connections causes the individual to experience poorer SEWB; to restore or strengthen connections in these domains is associated with increased SEWB (Gee et al., 2014).

Incorporating the Social and Emotional Wellbeing (SEWB) Framework into best practice eating disorder management

An aboriginal person experiencing disordered eating behaviours may face many complexities. For example, individuals may be experiencing cultural disconnection issues, stressors in the form of poverty, poor housing, child removal, trauma, abuse and transgenerational grief and loss (Gee et al., 2014). This complex management requires an integrated approach to engagement and eating disorder management.

This may include being aware of the social and cultural determinants experienced by the patient, promoting resilience through the strengthening of ties to family and community, recognising and supporting aboriginal spirituality and incorporating traditional healing methods alongside the clinical services offered by the multidisciplinary team required for eating disorder management (Dudgeon et al., 2015).

Literature suggests (Gee et al., 2014) that when working with aboriginal people within mental health and the SEWB framework, it is essential that health professionals:

• collaborate and build relationships within the community,
• have prior knowledge of the appropriate referral pathways,
• coordinate work with other service agencies,
• have access to a cultural mentor or consultant and,
• carefully consider the meaning of the signs and symptoms of distress experienced by clients.

All individuals living with an eating disorder require a safe environment, founded on trust in their health professional to provide the appropriate support necessary for recovery. A confident, culturally competent and culturally aware health professional will own the ability to acknowledge and value the significance of connection across various domains of aboriginal life to support the identification of, treatment for and recovery from an eating disorder (Bhui, Warfa, Edonya, McKenzie, & Bhugra, 2007).

For additional information on the Aboriginal Social and Emotion Wellbeing Framework, you may access the resource Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice online.

Additional resources on Aboriginal Health and working with Aboriginal and Torres Strait Islander groups are available through the below resources:

Aboriginal Indigenous HealthInfo Net: Provides support to those working in the Aboriginal and Torres Strait Islander health sector by making research and other knowledge readily accessible.

The Australian Indigenous Psychologists Association (AIPA): AIPA is the national body representing Aboriginal and Torres Strait Islander psychologists in Australia.

The National Aboriginal Community Controlled Health Organisation (NACCHO): NACCHO is the national peak body representing the Aboriginal Community Controlled Health Services (ACCHSs) across the country on Aboriginal health and wellbeing issues.

For immediate information and support about eating disorders and body image issues contact the Butterfly National Helpline on 1800 33 4673.

References

Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7.

Dudgeon, P., Walker, R., & Walker, R. (2015). Decolonising Australian Psychology: Discourses, Strategies, and Practice. Journal of Social and Political Psychology, 3(1), 276–297.
Gee, G., Dudgeon, P., Schultz, C., Hart, A., & Kelly, K. (2014). Aboriginal and Torres Strait Islander Social and Emotional Wellbeing. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Canberra: Australian Government Department of Health and Ageing.
Hay, P. J., & Carriage, C. (2012). Eating disorder features in indigenous Aboriginal and Torres Strait Islander Australian Peoples. BMC Public Health, 12(1), 233.
National Aboriginal Health Strategy Working Party. (1989). A national Aboriginal health strategy 1989. Canberra: Australian Department of Health and Ageing. 

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4. Sector News

• Butterfly Foundation - Employment Opportunity: Clinical Director

The Butterfly Foundation is dedicated to bringing about change to the culture, policy and practice in the prevention, treatment and support of those affected by eating disorders and negative body image. 

The Foundation operates the National Eating Disorders Helpline, a range of innovative clinical treatment and support programs across Australia, and delivers prevention initiatives in schools and the community.

The Role

Reporting to the CEO, the Clinical Director is responsible for the strategic leadership and clinical governance of Butterfly’s treatment programs and support services.

This role will have an unparalleled opportunity to influence and implement the clinical program model and framework for a new Australian residential facility for eating disorders, incorporating Butterfly's treatment philosophy and holistic approach towards eating disorders.

This position will be responsible for change initiatives, and for the safety and quality of all Butterfly clinical and support programs, operating in accordance with relevant professional codes of ethics and professional standards.

Skills Required

As a registered Clinical Psychologist, you will be a highly experienced clinician with advanced clinical knowledge of eating disorders with ability to provide expert clinical supervision in both individual and group settings.

Through your successful career in health focused organisations, you will have developed strong insights into the range of eating disorders treatment, and have demonstrated effective leadership in clinical service delivery and recovery focused interventions.

You have excellent people management skills with a genuine interest in employee well-being and in promoting a positive and ethical working environment. 

The full position description and additional information are available on the Butterfly Foundation website.

If you are driven to develop a thriving clinical team within our highly respected NFP, then please forward your cover letter responding to the skills required above and resume to hr@thebutterflyfoundation.org.au or call Luke Jesionkowski on 02 8456 3919 to discuss your interest.

• Eating Disorders Victoria: Training Opportunities

An interactive educational program designed to increase mental health literacy and helping behaviours in community members in contact with individuals developing or experiencing an eating disorder. It is an introductory level workshop suitable for people who do not have professional expertise in eating disorders but who work with those at risk — e.g. teachers, youth workers, welfare workers etc.

Next Training: June 19th 2019, 9am-1pm at EDV Abbotsford. $88 (GST incl.)
Bookings: https://www.trybooking.com/book/event?eid=477506&

* A Collaborative Approach to Eating Disorders for Exercise Professionals

A comprehensive four-hour education workshop for those working in the fitness/exercise industry. The workshop will explore: myths and stereotypes of eating disorders and obesity; striving for health in an eating disorder journey; understanding eating disorders; the fitness/exercise professional’s role; how to raise your concerns; how to support someone, when and where to refer for help, and how to build protective factors for good mental health with clients.

Next Training: July 24th 2019, 9am-1pm at EDV Abbotsford. $88 (GST incl.)
Bookings: https://www.trybooking.com/book/event?eid=477526&

• InsideOut Institute for Eating Disorders: National Strategy Consultations

•  CEED -  The Victorian Centre of Excellence in Eating Disorders: Training and Events

A full list of upcoming training and events, from workshops to conferences in Victoria and across the country, are available on the CEED Training and Events page.

If you have information to share across the sector, please contact the NEDC by email to include your submission in the NEDC e-Bulletin.