Dr. Suzanne Dooley-Hash almost didn’t make it to adulthood and a career as a doctor: from age 15, she was plagued by an eating disorder that took over, and nearly took, her life. She notes that today she has a high-powered career, she’s published in respected journals and she enjoys an excellent reputation in her field. By all outward markers, she’s a highly functional, successful woman — but she also very much views herself as in recovery from her eating disorder.
Eating disorders are complex, sinister illnesses that typically onset in the patient’s teens, and often require extensive treatment. The patient may need to be hospitalized, sometimes for an extended period of time, before being released into outpatient treatment and, eventually, follow-up therapy. Even with these measures, the patient may experience disordered eating habits for life, could be susceptible to returning to dangerous patterns and can also be subject to long-term health affects, like damage to the enamel of the teeth, or permanent heart conditions.
That’s why mental health interventions are so critical for children and teens, who can be just as ill as adults. However, they often require different kinds of interventions, and a specialized setting to ensure they get the most appropriate care possible. In Western Australia, the state appears to be failing patients: of the almost 30 ED patients who died in care between 2006 and 2011, fewer than five did so in hospital settings.
This is disturbing, as it suggests that the rest of these patients were ill enough to require hospitalization, yet weren’t placed in hospitals or residential care facilities for close monitoring, or didn’t get beds when they needed them for early treatment, allowing their conditions to progress. Patients with severe eating disorders require constant monitoring and treatment to ensure they’re getting adequate and appropriate nutrition, to provide them with counseling and coaching, and to look out for signs of comorbidities like depression that can complicate treatment.
Western Australia is unique among other Australian states in that it doesn’t specifically offer inpatient psychiatric treatment for adolescents with eating disorders, and it has no dedicated ward for this purpose. This means teens are placed on adult wards, which are not always an appropriate setting for their needs. While outpatient treatments offer a rich array of options, the lack of inpatient interventions is a serious problem when those in most critical need are those seeking hospital beds, leading some parents to send their children overseas for treatment.
Without access to a bed, a patient may be shunted to an adult psychiatric ward in a hospital setting where staff aren’t specifically familiar with adolescent psychiatry, and may not even be familiar with eating disorder therapies and recommendations. This short-changes patients, who may also be shuffled between institutions or denied hospitalization of any kind because of lack of confidence about where to put them. The end result can be fatal for people at a critical point in their illness, leaving them without the medical and psychiatric support they need to confront an eating disorder; for example, anorexic patients can develop severe cardiac arrhythmias which require immediate medical intervention, a service not available for someone on an outpatient status.
With eating disorders a pressing concern among adolescents, it’s clear that Western Australia needs a dedicated ED ward, something medical professionals are already recommending. Australians in need have waited too long for what should be a simple service.
Photo credit: Danielle Helm.