Eating disorders are serious, complex mental illnesses accompanied by physical and mental health complications which may be severe and life threatening. They are characterised by disturbances in behaviours, thoughts and feelings towards body weight/shape and/or food and eating.
People experiencing an eating disorder, along with their families and supports, may require access to a range of different services, at different levels of intensity or frequency, across the course of illness and recovery. Coordinated, evidence-based services that increase or decrease in intensity according to a person’s changing psychological, physical, nutritional and functional needs are known as the ‘stepped system of care’ for eating disorders. Progression along the continuum is not linear and response to treatment is individual and variable. People may require recurrent episodes of treatment, at different levels in the stepped system of care and from different service providers.
NEDC has developed a model of the stepped system of care for eating disorders, with examples of care and treatment services that people experiencing an eating disorder may require across the course of illness and recovery (shown below).
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Click on the drop down boxes to read more about each of the different levels.
Prevention, public health information and advocacy
Prevention, public health information and advocacy has an important role in preventing the development of disordered eating and eating disorders. Individuals and organisations across a broad range of sectors can contribute to this, including but not limited to governments, lived experience organisations, health professionals, schools, and in online settings.
Early identification and screening
Early identification and screening of eating disorders is important to support early recognition and intervention for people who may be experiencing an eating disorder. This can occur in any setting, including health care organisations, schools, and sporting organisations.
Initial response involves the completion of a comprehensive eating disorders assessment, preliminary diagnosis and referral to appropriate services according to a person’s needs. This can occur in public or private community-based health settings and can be conducted by primary health care professionals, mental health professionals, and dietitians, as examples.
Treatment extends across three levels of the stepped system of care, with the treatment intensity increasing across these three levels. Decisions about the level of treatment required must be made depending on the severity of the eating disorder symptoms informed by the evidence for eating disorders and the potentially high risks associated with treatment failure at lower levels of intensity. As such, the lowest level of treatment may not be an appropriate starting point for treatment. For example, inpatient services may be required as soon as someone is identified as having an eating disorder.
The first treatment level is community-based treatment, which refers to evidence-based treatment delivered in the community or outpatient setting, with coordinated access to a range of services as needed. This can be delivered by appropriately skilled public or private community-based health professionals. It can include the provision of online guided self-help, where appropriate. Community- based treatment can be used as a step in at first diagnosis or first occurrence of symptoms, or a step down from community-based intensive treatment or inpatient treatment.
The second level of treatment is community-based intensive treatment, when treatment at a higher frequency and intensity is required. This can be delivered in the community through intensive outpatient programs and day programs. Community-based intensive treatment can be used as step in at first diagnosis or first occurrence of symptoms, a step up when a patient is not responding to community- based treatment, or as a step down from inpatient treatment.
The third treatment level is hospital treatment, when medical and/or psychiatric intervention or a high level of treatment and support is required. This can be delivered in emergency departments, medical and psychiatric inpatient units, eating disorder-specific inpatient units, and eating disorder-specific residential programs. Inpatient treatment can be used as a step in at first diagnosis or first occurrence of symptoms when a patient is at medical and/or psychiatric risk. The patient can also step up to inpatient treatment for medical and/or psychiatric intervention to manage complications and risk or if the patient requires a structured inpatient eating disorder program.
Recovery support refers to the provision of community-based and online services to support ongoing recovery and to reduce the risk of relapse and illness recurrence. These services and support can be provided by primary health care professionals, community-based mental health and dietetic services, and support groups. Online resources can also support recovery.
Principles, standards, lived experience and research
Underpinning the stepped system of care are key principles, standards and research, including the National Practice Standards for Eating Disorders, NEDC’s Workforce Core Competencies for the safe and effective identification of and response to eating disorders, the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders, and the Australia and New Zealand Academy for Eating Disorders (ANZAED) eating disorder treatment principles and general clinical practice and training standards.
Alongside these principles, standards and research, lived experience input throughout the design, delivery and evaluation of services within the stepped system of care is essential.
Care team approach
During treatment regardless of the treatment setting, a care team approach is required which includes medical and mental health care professionals at a minimum, dietetic care as appropriate, and other mental health and medical input in line with the person’s needs, including peer workers. Family and supports are an integral part of the care team. For further information, see a comprehensive description of the care team required for people experiencing eating disorders here.