Until 2018, there was no specialised treatment for adults with an eating disorder who were referred to the Richmond Adult Community Mental Health Service (RACMHS).
This project implements a clinical pathway for referral and treatment that includes screening, triage, and assessment; and provides adults referred to RACMHS with cognitive behavioural therapy – enhanced (CBT-E). This is a form of cognitive behavioural therapy specifically for eating disorders.
Aim
From December 2018 onwards, RACMHS offers specialised eating disorders treatment, which is CBT-E, for 100% of eligible adults referred.
Benefits
Benefits include:
- patients receive appropriate and specialised treatment for their eating disorder
- improved rate of recovery
- prevention of further deterioration and subsequent hospital admissions
- financial savings for the healthcare system from less expensive admissions
- clinicians are trained to provide therapy within their community.
Background
The NSW Service Plan for People with Eating Disorders 2013-2018 stipulates that eating disorders are a core business for community mental health services.1
Previously there was no specialised treatment available in community mental health for adults with an eating disorder. People under 18 years with an eating disorder were offered family-based therapy, but when referred to the adult team, there was no specialised treatment offered for eating disorders.
This meant that their eating disorder was inadequately treated, the person was referred out privately, or they required hospital admission for deterioration in their physical health.
Implementation
The project team implemented a number of solutions including:
- development of a screening tool for eating disorders, and adding this as a pre-completed note on the electronic medical record so that screening takes place at triage
- development of a clinical pathway, tracking the client through from referral to treatment. This was tabled at the RACMHS clinical governance meeting, and then implemented across the RACMHS
- two CBT-E training days were held, and nine clinicians were trained in CBT-E as a result
- an eating disorders team was formed to provide a hub for new referrals to be discussed and allocated, and care planning developed. The team also provides supervision and support for staff, and evaluation of treatment outcomes.
Status
Sustained – The project has been implemented and is sustained in standard business.
Dates
March 2018 to present
Implementation sites
Richmond Adult Community Mental Health Service
Partnerships
Clinical Excellence Commission, Clinical Leadership Program
Results
The project has been successfully implemented, and 10 referrals were received during the first six months of implementation. All clients referred have been offered CBT-E and there are currently 13 clients receiving CBT-E, at the time of writing.
Further data will be collected across 2019 to look at recovery rates, reduced hospitalisations and number of referrals received. This service requires extra resources and funding in order to continue.
Lessons learnt
These include:
- to delegate wherever possible to share the workload, and bring in new ideas
- to always inform staff of any changes to policies and processes
- to provide adequate education and training to meet staff needs.
References
- NSW Ministry of Health. NSW Service Plan for People with Eating Disorders 2013-2018. North Sydney: NSW Ministry of Health; 2013.
Further reading
- Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017.
- Fairburn C. Cognitive Behaviour Therapy and Eating Disorders. New York: The Guildford Press; 2008.
Contact
Jill Crighton
Acting Clinical Nurse Consultant
Lismore Community Mental Health
Northern NSW Local Health District
Phone: 0401 000 961
jillian.crighton@health.nsw.gov.au
