What about us? Struggling to access specialist care for eating disorders in rural communities

  • Images from first round of FBT Training with Professor Daniel Le Grange from University of California, San Francisco.
    Left to right: Ashlea Hambleton (project coordinator), Danielle Maloney (Deputy Director, InsideOut Institute), Prof Daniel Le Grange (University of California, San Francisco) and Assoc Prof Sarah Maguire (Director, InsideOut Institute).
  • Images from first round of FBT Training with Professor Daniel Le Grange from University of California, San Francisco.
    Prof Daniel Le Grange delivering FBT training at a workshop with rural and regional clinicians.

Each year, one million Australians and their loved ones are impacted by the physical, emotional, social and economic burden of eating disorders. Eating disorders are serious, potentially life-threatening conditions which do not discriminate by gender, age, education or sociocultural group.

Although generally a low-funded health area, there are some treatments with a developing evidence base. However, the provision of these treatments requires specialist training and supervision, which is often inaccessible in rural and regional communities.

Anorexia nervosa and treatment

Anorexia nervosa (AN) is an eating disorder often diagnosed in adolescence and characterised by restrictive food intake, a significant fear of weight gain and disturbed body image. For children and adolescents with AN, the evidence-based treatment is family-based treatment (FBT), which relies heavily on family involvement in re-feeding their child, using specific amounts of foods and scheduled mealtimes.

The implementation of FBT within rural health services is challenged by several factors unique to the rural setting. Practically, there are limitations to service accessibility due to geography, with some health districts spanning land areas as large as some European countries.

Typically, FBT is delivered face to face and, for some families, the distance between home and service is too great a barrier. From a service perspective, there is a concerning inequity in access to specialised eating disorder care for rural populations, despite the prevalence of mental illness being comparable across the nation.

InsideOut Institute’s solution

The InsideOut Institute for Eating Disorders, a collaboration between the University of Sydney and Sydney Local Health District, aims to address this disparity through service and policy development. We identified the need for equity of service provision, regardless of where someone lives, by ensuring that effective, evidence-based treatment is delivered safely and effectively closer to home.

The InsideOut Institute is delivering a pilot project, FBT Via Telehealth, where we are testing the translation and implementation of telehealth into rural health services, to deliver FBT directly into the homes of young people with AN. Prior to commencing the project, we identified a gap in workforce expertise.

To this end, we delivered three rounds of specialised training in FBT to nominated clinicians in health services. Further, we have implemented a ‘train the trainer’ model, with the aim to improve sustainability of workforce expertise and knowledge. We also expanded our education program with the provision of a regular supervision group for rural clinicians with an international expert in the treatment of AN in young people.

Unique challenges

Throughout the course of the FBT Via Telehealth project, we have observed the unique workforce challenges rural and regional health services are managing. Of the 19 therapists originally trained, only seven remain in the project. This attrition has been largely a consequence of the impact of the 2020 bushfires, 2021 and 2022 flood crises and, of course, the COVID-19 pandemic.

These events have led to additional demand for mental health services, while also creating a rapid shifting and transience in the workforce – clinicians have been on secondment to fill disaster relief roles, moved out of the area to be closer to family or were promoted to clinical lead positions while also holding a caseload, to manage gaps in staff numbers. Despite their best efforts, this means the healthcare system is overstretched, with lengthy wait times for urgent treatments.

While telehealth is a possible solution to bridge the geographic gap and accessibility barriers for rural and regional consumers and health services, its success will be limited if health services are understaffed, which in turn risks a burnt-out workforce and high rates of staff turnover.

High rates of workforce transience reinforce the importance of ongoing research focus in this area, to develop pathways and programs that support the health system while also filling access gaps.


Presenter at the National Rural Health Conference

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