Food for Thought

Published 29 March 2019. Last updated 12 April 2019.

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.


From December 2018 onwards, RACMHS offers specialised eating disorders treatment, which is CBT-E, for 100% of eligible adults referred.


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.


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.


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.


Sustained – The project has been implemented and is sustained in standard business.


March 2018 to present

Implementation sites

Richmond Adult Community Mental Health Service


Clinical Excellence Commission, Clinical Leadership Program


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.


  1. NSW Ministry of Health. NSW Service Plan for People with Eating Disorders 2013-2018. North Sydney: NSW Ministry of Health; 2013.

Further reading


Jill Crighton
Acting Clinical Nurse Consultant
Lismore Community Mental Health
Northern NSW Local Health District
Phone: 0401 000 961


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