Issue 30 | Workforce Development for Eating Disorders Management
About this resource
Welcome to the thirtieth edition of the NEDC e-Bulletin. In this edition of the e-Bulletin we're highlighting workforce development as a core component of effective treatment of eating disorders in Australia.
Workforce development for the prevention and management of eating disorders
The need for Workforce Development is essential for a nationally consistent approach to the prevention and management of Eating Disorders. People with eating disorders have serious and complex illnesses which require treatment that is specific to their disorder, specific to the severity of their illness and specific to the clinical stage they are in, from risk to recovery.
Why Workforce Development?
A highly trained and specifically trained workforce is required for the effective treatment of eating disorders (ANZAED, 2011). At present few clinicians are specifically trained to diagnose and treat eating disorders. Almost half (82) of clinicians consulted by the NEDC, 2014, indicated that they received no formal instruction about eating disorders. Walker & Lloyd, 2011, suggest that health professionals feel they do not adequately understand the eating disorders experience and fear worsening the condition.
In many instances a patient will seek help or treatment for another issue, when the real and underlying illness is the eating disorder (Hudson and colleagues 2007). Individuals with eating disorders are typically first seen by their family or primary care physician Clarke & Polimeni‐Walker, 2004, even if they may not receive treatment for their eating disorder from these health care providers. GPs, pediatricians and nurse practitioners are therefore a priority group for access to training.
For specific at-risk groups, specialist health services providers may represent the first point of contact. For example, for women presenting with eating disorder symptoms later in life, the first point of contact may be a gynaecologist or midwife (Newton & Chizawsky, 2006); for people seeking treatment for diabetes or obesity, an endocrinologist or a diabetes educator may be the first point of contact (Pereira & Alvarenga, 2007). Athletes may first seek help from specialists in sports medicine or physiotherapy, whilst people who frequently use self-induced vomiting purging techniques may first be identified and access help through a dentist.
Eating disorders are struggling to be identified as ‘core business’ for frontline services, which has contributed to a barrier to early intervention and referral pathways. The goal of workforce development is to make the treatment of eating disorders ‘core-business’. A nationally consistent and standardized approach is necessary to ensure a skilled and knowledgeable workforce trained to participate in the multi-disciplinary treatment of eating disorders.
What is Workforce Development?
Workforce Development is essential for a nationally consistent approach to the prevention and management of Eating Disorders. Workforce Development aims to identify existing workforce needs and proposes a workforce model to address these needs. Workforce Development can be broken down into three major components: Professional Development, Service Development, and Standardized Systems of Delivery.
A skilled workforce includes not only specialists in eating disorders but also other health professionals, teachers and educators and those from other relevant fields such as the fitness, fashion, modelling, advertising and weight loss industries. These various groups can be summarized into the following five core categories: Early Identifiers, Initial Responders, Tertiary Level Clinicians, Shared Care Treatment Providers and Recovery Support Providers.
Workforce development can provide a basic foundation for all professionals and ensure that persons with eating disorders have access to a continuum of care from prevention to early intervention, treatment and recovery.
While some knowledge and skills may be profession specific, there are also foundation skills or competencies that are shared across all disciplines. The basic foundation is the knowledge and ability to identify someone at risk of an eating disorder. As roles increase in their responsibility and intensity of involvement with a person with an eating disorder, professions require different training to add competencies to this basic foundation.
At a national and state level, it is important that service development and professional development is coordinated and planned together to ensure consistency between states and to make effective use of limited resources.
Australia and New Zealand Academy for Eating Disorders (ANZAED), (2011). Submission to the Senate Community Affairs Committee regarding the Inquiry into Commonwealth Funding and Administration of Mental Health Services. ANZAED, Sydney.
Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The Prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61(3), 348-358.
The role of mental health nurses in eating disorder prevention, intervention, treatment and recovery support
By Kim Ryan
For a long time, people with eating disorders have not received the systematic attention that they deserve. There has also been significant stigma attached to living with an eating disorder. This stigma stems from the many myths that exist about the disorders, which are perpetuated by the media, and accepted as truths by the broader community and many practitioners within the health sector. The fact is that eating disorders are serious mental illnesses which impose a significant health burden on Australian men, women, children and young people. Eating disorders have high rates of morbidity of mortality and significantly compromise quality of life and family wellbeing.
While eating disorders are clearly serious mental illnesses, they also have significant physical symptoms and potentially life threatening medical complications. As such, there has been disagreement around whether people with eating disorders should be treated in mental health or general health settings. The current focus on better integrating mental health and physical health systems, treating people in a more holistic way, can only benefit people with eating disorders, who need treatment from a range of professionals to address their complex and varying needs – including from mental health nurses.
What level of involvement mental health nurses have with people who have eating disorders will depend on their clinical area of practice, as well as their knowledge, skills and interest in the area. However, an awareness of the illnesses and an ability to identify those at risk and pick up on signs and symptoms of early illness is an important role for all nurses, across all clinical settings – not just mental health nurses. Because eating disorders are often secret illnesses, and many people with eating disorders never seek treatment, the illness goes unrecognised - affecting quality of life and increasing the risk of the development of co-morbid mental and physical illness. All nurses need to be open to enquiring about a person’s feelings around their body image, weight and shape, and the impact these issues have on their general wellbeing; and all nurses need to develop an empathic and mindful approach to people who they believe to be at risk of, who are developing, or who are presenting with frank symptoms or complications of an eating disorder.
From a prevention perspective, eating disorder prevention and health promotion is similar to other mental health prevention/promotion, in that the focus should be on developing resilience – on media literacy, on assertiveness, on developing good communication and coping skills. Providing young people with access to support around managing stress and reducing anxiety, as well as general nutrition and healthy lifestyles information is important, but not with a focus on weight or body shape, more with a view to health and wellbeing.
Mental health nurses work with people at risk of developing a range of mental health issues, and should be ever mindful that an eating disorder may be present - particularly those who work in services with children and young people. Supporting young people to deal with difficult issues, such as bullying, sexuality, managing school pressure and workload, addressing communication problems and tensions within families – these are all ways that mental health nurses engage with people at risk of developing eating disorders and other mental health problems in a health promotion/illness promotion approach.
Of course, mental health nurses are also an important member of the eating disorder health care team. In specialist settings, such as inpatient units, day programs, outpatient clinics and in primary care eating disorder teams (whether these are co-located, or disparate professionals who form a loose community-based ‘team’), mental health nurses coordinate care and provide supportive therapy to people with eating disorders. They help people manage the very significant physical and mental health effects of the illness, they support people through the recovery process (which is in and of itself extremely anxiety provoking), they work with families to help them to support their loved one to recover, they liaise with other members of the team (e.g. dietitian, psychiatrist) and they address underlying issues through psychotherapy, family therapy and/or a range of other evidence based treatments – depending on their specific skill set and the person’s individual needs.
Kim Ryan is the CEO of the Australian College of Mental Health Nurses, Chair Coalition of National Nursing Organizations and Adjunct Associate Professor – University of Sydney. Kim Ryan trained as a general nurse and then went on to complete her mental health nursing qualifications. Kim has been working in mental health for over 20 years in a variety of settings, these include acute, community, corrections health, recovery, and over the last 10 years she has held numerous administrative positions.
Kim will be facilitating a session at the 2015 NEDC Members’ Meeting on Placing eating disorders on the frontline of workforce training and development.
New Event: 2015 NEDC MEMBERS’ MEETING
To be held on the 22nd June 2015 at the National Convention Centre, Canberra, the 2015 NEDC Members’ Meeting is a free members only forum that will showcase the collective impact of knowledge building and research in eating disorders.
Members’ Meetings are convened by the National Eating Disorders Collaboration (NEDC) to enable our diverse and invaluable membership to come together and contribute, share knowledge, discuss treatment, recovery and current issues in the eating disorders sector, and learn about new initiatives in evidence-based research and treatment from eating disorders experts. The event has two keynote speakers: Professor Susan Paxton and Dr Sarah Maguire.
Attendees can expect to:
- Engage with experts in emerging methodologies in research, treatment and recovery
- Build intersectoral and interdisciplinary coordination and evidence sharing on eating disorders
- Engage with NEDC plans and projects including providing suggestions, requests and recommendations
- Access opportunities for professional networking
The event carries no cost and all attendees will receive a Members’ Pack including a suite of evidence based resources.
If you would like to attend the event but are not yet a member you can access free sign-up to the collaboration on our website.
Eating Disorders: a Professional Resource for General Practitioners
As General Practitioner is likely to be one of the first health professionals a person with an eating disorder will come in contact with.
A General Practitioner’s role in the treatment of eating disorders can encompass prevention, identification, medical management in a primary care setting and referral.
NEDC have developed a professional resource for GPs to support their role in the treatment of eating disorders which can encompass prevention, identification, medical management and referral. This resource is divided into three sections covering screening and assessment, referral to appropriate services and ongoing treatment and management. The resource encourages General Practitioners to act as an approachable ‘first base’ for those seeking help.
Can patients with eating disorders learn to eat intuitively? A 2-year pilot study
The present article reports on a 2-year pilot study that evaluated the effectiveness of an intuitive eating program for patients in an eating disorder treatment center.Read more
Orthorexia prevalence among health care professionals involved in nutrition education: The ADI-O study
BACKGROUND: Orthorexia Nervosa (ON) is defined as a pathological fixation about the consumption of healthy food.Read more
National Eating Disorders Collaboration Consultation Papers: Evidence in Practice Implementing the National Framework
The National Eating Disorders Framework standards schema includes seven core principles and fourimplementation principles which, if implemented together, provide the foundation for an effectiveand consistent system to address eating disorders.Read more
An Integrated Response to Complexity. National Eating Disorders Framework.
An Integrated Response to Complexity: National Eating Disorders Framework 2012 is the first national schema for eating disorders in Australia.Read more