For early intervention and timely treatment to occur, it is essential that professionals working with those at high risk of eating disorders proactively identify symptoms and engage people in help seeking. However, a review conducted by the NEDC in 2013 showed that 97% of general clinicians interviewed had little or no sufficient training in the field of eating disorders (NEDC, 2013). This may be due to the fact that in Australia, eating disorders are not included, or sufficiently included, in undergraduate qualifications to enable health professionals to confidently treat patients with an eating disorder (The Butterfly Foundation, 2015, p.9). Such findings raise an important question - What eating disorders specific training is available for Australian Health Professionals and how could we further develop a national approach to this?
Tertiary Education and Continuing Professional Development
Research indicates that professionals lack confidence in treating eating disorders and findings highlight an urgent need for increased training in screening, diagnosis, referral and early treatment of eating disorders (Hay, Darby & Mond, 2007; Brownlow, Maguire, O’Dell, Dias-da-Costa, Touyz & Russell, 2015). Currently, eating disorders education within Australian Universities is limited and appears to rely heavily on particular research interests of University faculties (NEDC, 2013; Wallace & Ransom, 2012). In addition to this, ongoing eating disorders training for health professionals is currently disseminated through state and national organisations. Access to such training is at the discretion of employers and is often voluntary participation, rather than mandatory (NEDC, 2013). Further barriers include cost, time availability and location of training. Such challenges in accessing specific training, may support the finding that although there has been a significant increase in eating disorders presentations, approximately 50% of health professionals reported receiving no formal training in 2013 (NEDC, 2013, p.7). A particular Australian study revealed that many professionals found eating disorders difficult and time consuming to treat (Hay, Darby & Mond, 2007). There was also a view by professionals that they had to specialise in eating disorders to provide effective support (Hay, Darby & Mond, 2007; Walker & Lloyd, 2011).
In response to this need and the potential barriers, Brownlow et al. (2015) evaluated the effectiveness of an online eating disorders module developed for health professionals in Australia. The study showed that after the completion of the online program, professionals reported a significant increase in their confidence and clinical skills in assessing and treating eating disorders (Brownlow et al., 2015). A reduction in stigmatised beliefs towards eating disorders was also noted.
The recurrent themes of lack of confidence, stigma and limited training highlight the need for eating disorders education to be included in Tertiary Education and Continuing Professional Development. This would increase the knowledge of all health professionals, enabling a collaborative approach to diagnosis and early treatment of eating disorders.
The implementation of core competencies for health professionals is a national priority to effectively address eating disorders. This is consistent with the Fourth National Mental Health Plan, which encourages a streamlined National Mental Health Workforce (Priority Area 4, Fourth National Mental Health Plan, 2009). At present, in Australia, there are no defined competency standards for professionals who treat eating disorders (NEDC, 2013, p.83). Implementing practice standards will promote a coordinated and consistent approach to professional development and service improvement (Australian Government Department of Health, 2013). Williams and Haverkamp (2010) argue that given the serious nature of eating disorders, clinicians who practice beyond their level of competence may actually do so at the client’s physical, mental and emotional detriment. A Delphi Study, focusing on current literature and participant input, identified five key competency domains for meeting a minimum level of psychotherapeutic competence in treating eating disorders - knowledge and skills, interdisciplinary teamwork, specialised therapeutic relationship skills, professional responsibility and therapist characteristics (Williams & Haverkamp, 2010, p.105). Self-assessment through systematic criteria was also deemed valuable in identifying and developing professional competence. The Butterfly Foundation (2015) acknowledge the potential financial benefit of standardised practice through proposing that an adoption of best practice approaches to eating disorders early identification and treatment would contribute to productivity benefits and other gains to the economy of around $15.1 billion (NPV) by increasing rates of sustained recovery and reducing the need for intensive and recurrent treatment’ (pp. 12 – 13)
The Fifth National Mental Health Plan is currently in development by the Commonwealth Government and due to be released in the coming year. This document will highlight the future direction for mental health and may reinforce core competencies as a priority in the field of eating disorders. The development of competency standards would establish a skilled workforce and streamline the treatment of eating disorders to ensure a consistent, evidence-based approach.
Extensive research shows that effective treatment of eating disorders requires a multidisciplinary team (Hay et al., 2015; De Jesse & Zelman, 2015). In light of this, there is an increased need for peak bodies and professional disciplines to openly communicate and attend cohesive training in order to streamline research, knowledge and treatment approaches (Fourth National Mental Health Plan, 2009, p.32). De Jesse & Zelman (2015) explored the professional relationship between mental health providers and nutritionists and found that despite both having similar projected client outcomes, their collaboration is often challenged due to different training and treatment philosophies. Professional disputes commonly result in broken professional relationships, consequently jeopardising effective treatment of clients. In order to overcome such challenges, two possible approaches have been identified – implementing mandatory training in professional communication, negotiation and collaboration and inter-professional training, where conjoint training sessions are held for students and professionals within different disciplines (De Jesse & Zelman, 2015). The proposed strategies would ensure a collaborative and consistent approach to early intervention and treatment of eating disorders.
As seen, the current scope of professional development opportunities for health professionals in Australia is limited and presents many challenges. The implementation of mandatory tertiary education and CPD, the development of core competencies and collaboration between professional bodies, would allow professionals to be equipped with adequate knowledge, skills and critical thinking to proactively engage in eating disorders training. A competent and subsequently confident workforce would result in a consistent, national and evidence-based approach to the treatment of eating disorders.
Australian Government Department of Health. (2013). National practice standards for the mental health workforce, 1–26.
Brownlow, R. S., Maguire, S., Dell, A. O., Dias-da-costa, C., Touyz, S., & Russell, J. (2015). Evaluation of an online training program in eating disorders for health professionals in Australia. Journal of Eating Disorders, 1–6.
Butterfly Report. (2015). Investing in Need - Cost-effective interventions for Eating Disorders, 1–74.
Commonwealth of Australia. (2014). Fourth National Mental Health Plan - An agenda for collaborative government action in mental health 2009-2014.
Dejesse, L. D., & Zelman, D. C. (2013). Promoting Optimal Collaboration Between Mental Health Providers and Nutritionists in the Treatment of Eating Disorders. Eating Disorders : The Journal of Treatment & Prevention, 21(3), 37–41.
Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., … Ward, W. (2014). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian & New Zealand Journal of Psychiatry, 48(11), 977–1008.
Hay, P., Darby, A., & Mond, J. (2007). Knowledge and beliefs about bulimia nervosa and its treatment: A comparative study of three disciplines. Journal of Clinical Psychology in Medical Settings, 14(1), 59–68.
National Eating Disorders Collaboration. (2013). Gap Analysis: A Nationally Consistent Approach to Eating Disorders.
Walker, S., & Lloyd, C. A. (2011). Barriers and attitudes health professionals working in eating disorders experience. International Journal of Therapy and Rehabilitation, 18(7), 383–391.
Wallace, L. M., & Ranson, K. M. Von. (2012). Behaviour Research and Therapy Perceptions and use of empirically-supported psychotherapies among eating disorder professionals. Behaviour Research and Therapy, 50(3), 215–222.
Williams, M., & Haverkamp, B. E. (2010). Identifying critical competencies for psychotherapeutic practice with eating disordered clients: a Delphi study. Eating Disorders, 18(2), 91–109.