Can I share, with permission, the story of a patient of mine. She has had an eating disorder for some time, a long time. At times she wants to keep it, at times she wants to be free from it. Many of these times happen at the same time.
She had being doing as well as she had done for a long time. She had not needed intensive treatment in an eating disorders unit or a day program or a medical unit for over a year. This was the first time she had been able to do this for some years. She was able to reconnect in a deep and meaningful way with her children and husband. Life was becoming meaningful and worth living. I have a lot of time for this patient. I have learnt much from her about how to be a better therapist and, in a lot of ways, how to be a better person.
Then she got sick again, very sick, life threateningly sick. It took a while, but she agreed that eating by herself, even with her husbands support, was being made too hard by the anorexia. She needed to go to hospital. At times she could see that the anorexia was so in control she would not be able to eat in hospital (this has happened before). Together we decided that we needed to admit her to a hospital to be tube fed so that she could again restart the process of nutritional recovery.
The hospital where we had done this before had been closed. It was a private unit and didn’t make shareholders enough money. Another private unit had a long waiting list and had a policy of not using tube feeding. They seemed to think that patients should not “cop out” and require a tube. This confused us.
So despite having private health cover, the private health system was not able to help. So we turned to the public system, as all those without private health cover need to. In NSW there are two adult beds designated for patients with eating disorders. These beds are in a general psychiatric unit within a medical hospital. Perhaps not surprisingly, these beds were occupied and there was a long waiting list.
There was another option. There is an excellent hospital in Sydney’s West. It is internationally renowned for its treatment of children and adolescent with eating disorders. They also have access to some beds for adults with eating disorders. They have a great team with great people with high levels of expertise and experience in helping patients just like mine.
One of the first questions the intake officer asks you is your post code. If you don’t have the right post code, you don’t get access to adult treatment.
Working with the GP and my patient talked to a consultant psychiatrist who was willing to accept the patient and treat with the intensity needed to save a life. There was a bed available. However, there was that post code problem. We were told however, that we could probably gain access to a bed if we wrote to the Minister for Health explaining the clinical need.
Three letters were written.
One response received.
“I understand that the patient is very unwell and is likely to need artificial feeding and a full physical assessment. Given the clinical situation described.. I would strongly recommend the patient attend the closest Emergency Department as soon as possible”.
Well, thats a no then. We had thought of the option of a medical admission at the local hospital, but our experience is that the response has been rehydration (with the risk of refeeding syndrome) and discharge. The response ignored that anorexia is a mental illness with severe and life threatening physical complications. It requires specialist treatment.
All patients deserve access to the best possible treatments irrespective of their post code.
If you don’t think the above scenario is acceptable. The I ask you to sign the petition that you can get to via the link below.
https://www.change.org/petitions/nsw-health-it-s-time-to-provide-adequate-care-for-eating-disorders-patients-in-nsw
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