The need for public inpatient eating disorder treatment

Today I attended a forum for consumers and carers to discuss the 10 Year Mental Health Services Plan, facilitated by the state Mental Health Commission. The four categories discussed were bed based services, community clinical services, community support services and prevention & promotion. There has been talk of this already, but one of the points I raised under bed based services was the need for a specialised inpatient eating disorders program for adults. Currently in my state there’s an inpatient eating disorders program at the children’s’ hospital for those under 16 years old, and for adults there’s one at a private hospital which is only accessible for those with private health insurance. In the public mental health system this is non existent, so you either get put in a general acute mental health unit or you get nothing.

This is problematic for a number of reasons. As we all know, the number of beds in psych wards are limited, and there’s almost always greater demand than there are beds available. Most beds are occupied by those who are suicidal, have psychotic or affective disorders. Even those who are suicidal sometimes get turned away. So if you have an eating disorder, unless you’re quite underweight or physically compromised, there’s slim chance you’ll get inpatient help for it. It seems as though EDs being treated in acute psych wards are so rare that nurses were quoted saying to me “Last time we had an eating disorder patient here….” It’s hard enough to eat and recover with supervision and inpatient care, I imagine it would be even harder to do so on an outpatient basis. It just doesn’t seem fair that it’s so hard to get that help if you’re in the public system.

Then there’s the care for when you are an inpatient. It’s better than nothing. But there are also many reasons why an acute psych unit isn’t appropriate. I get that it’s hard to cater for everyone, but often groups weren’t all that relevant. I know that at the private ED program, the groups offered are actually somewhat relevant to those with EDs. The focus while I was inpatient was all on just food and weight and there was nothing to help with the psychological side of it.

There were some staff members who did seem to have experience and knowledge of EDs, but then there were others who did not. I got nurses from one extreme, who told me I’d eventually be dead if I didn’t come to hospital, to the other extreme who asked me “Why are they so worried about you anyway?” and told me “I thought you’d be home by now.” I got the feeling some nurses wondered why I was in hospital and didn’t think I needed to be there. There were nurses who didn’t seem to get that it’s not that easy and would tell me “Just eat and put on the weight so you’ll get to go home, simple,” as if there wasn’t a battle going on in my head when it comes to doing so. When I was caught exercising and told to stop by the nurse, “Put on the weight so you can get out of hospital, then when you get home you can do what you want.” Lol, kinda defeats the purpose of being in hospital, but ooookay then.

There was even one nurse who asked me how I managed to lose weight on more than one occasion. Eventually I asked her “Why would you ask someone with an eating disorder that?” There was a particular conversation I remember she was having with my friend on the ward and myself. The nurse was talking about being envious that Asians are all so slim and and asked me how it is that Asians do stay slim and what they eat to do so. “Rice,” I answered. She laughed and said no, she’d probably gain weight if she ate rice. This conversation was upsetting to me as I feel like I’m meant to be thin because I’m Asian. Because I’m Asian, even at my lowest weight, by Asian standards it’s not even considered skinny- just average. And if I gain weight and go back to my highest weight of ~43kg, it’ll be considered fat for an Asian.

Then there are aspects that I, or rather my ED, likes that some staff aren’t experienced. Times when my Ensure Plus has ended up down the drain rather than down my oesophagus and into my stomach when I haven’t been watched or watched closely enough. Times when I’ve managed to hide and/or throw food in the bin. When at a mealtime a nurse has said, “I’m meant to watch you eat but I won’t, just makes sure you have everything you’re meant to have.” Lol, sure I will. It seems like some don’t realise how sneaky eating disorders can actually be. Before I got caught out, I managed to go a few times to weigh in wearing multiple items of clothing and hiding extra weights on me. A friend who’s been through the private eating disorders program couldn’t believe I’d gotten away with that- it seems that over there where they specifically treat EDs, they’re a lot more clued in to the tricks that people with EDs use. One morning when I’d been up early, I blatantly had two cups of coffee before weigh in and didn’t hide it, and they didn’t pick up on it or say anything and weighed me as usual.

One advantage I will say though of not being in a specialised eating disorders program is that I was the only one in the ward at the time being treated for an eating disorder. I worry that if I were to attend an eating disorder program, I’d be triggered by patients who were thinner than me, or who ate less than me. When you’re the only one in the place who has an ED, there is far less competition for who can be the thinnest, who can be the sickest, who can eat the least.

6 thoughts on “The need for public inpatient eating disorder treatment

  1. Pingback: The need for public inpatient eating disorder treatment | Behind the ... | Bulimia 10 | Bulimia 10

  2. The public system is tricky… it completely sucks, but I think that’s generally because of a lack of funding. I’ve been in the public system in WA and Victoria. No admissions in WA – lol, my tiny country town’s hospital had no real psych ward, but a few here in Victoria.

    They don’t know how to manage much aside from things they can medicate – schizophrenia, bipolar, depression, anxiety, drug & alcohol issues. Sometimes you come across wonderful staff in the public system but they seem few and far between.

    I’m between public and private at the moment – public team are desperate to discharge me, but can’t find a private psychiatrist to take me. I have a private psychiatrist who admitted me in July for trauma issues, and may admit me now for ED stuff. My public team however… think nothing’s wrong with me, that I’m okay, functioning well etc. despite everything I tell them.

    I know some states are really lacking with public ED beds… which is sad. Most states are lacking any decent public treatment for adults with ED’s which is sad 😦 Not everyone is a teenager or under 25.

  3. It doesn’t sound like the program helped you very much. From what you have written, you are back to your old habits. So even if there were more public inpatient treatment units, I wonder how effective they might be?

    It is similar in my country (the U.S). Most ED Treatment centers are private, and you need private health insurance to access them. The Public options are generic mental health units which are short-term and not as helpful.

    But at the end of the day, it it ultimately up to you – not the nurse, physician, or psychologist – to get the Ensure down your esophagus. No one can babysit you 24/7 to ensure that you eat/drink adequately. Plus ED patients often throw the food back up anyway. I don’t know if you have Bulimia but the damage to your intestines, esophagus, and stomach lining can be permanent :/

  4. Could you see a role for yourself as an occupational therapist in the inpatient unit? I agree it doesn’t sound like being in the public MH hospital helped you much. What is next?

  5. Please update us on your condition! I saw your instagram and I am worried for you. You had such a negative experience last time that I wonder how this will be any different for you? I know we don’t know each other but I feel like I’ve gotten to know you through your blog and I care about your progress.

    I hope this stay is a bit more productive for you and easier on your fragile self.

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