The COVID-19 pandemic and Victoria’s protracted lockdown to contain the virus has triggered a wave of destructive eating disorders in teenagers and young adults, with the demand for treatment overwhelming available services and spilling into hospital wards and emergency rooms.
Christine Morgan, the National Mental Health Commission chief executive who advises the Prime Minister on suicide prevention, said data provided by hospitals and support services showed a national surge of between 25 and 50 per cent in presentations for eating disorders across the public health system.
National Mental Health Commission chief Christine Morgan with Prime Minister Scott Morrison.Credit:Alex Ellinghausen
In Victoria, the situation is so dire that some of Melbourne’s leading private practices specialising in eating disorders have been forced to close their doors to new patients.
The extent and seriousness of the problem was revealed to The Sunday Age during a six-week examination of the Victorian government's response to the second wave epidemic, which killed more than 800 people and plunged the state into lockdown.
Kevin Barrow, the chief executive of the Butterfly Foundation which runs a national helpline for people with eating disorders, said a shortage of trained clinicians was aggravating what is likely to be a long-term health consequence for young people.
“If you are in need of care you just can’t get in to see somebody,’’ Mr Barrow said.
“The evidence suggests the earlier you get into treatment, the better chance of recovery. Unfortunately the converse is also true. I think we are going to be dealing with these challenges for quite some time to come.’’
Youth mental health expert and Orygen executive director Patrick McGorry said a “mini moonshot’’ was required from government, researchers, and clinicians to better understand eating disorders and how to treat them. Ms Morgan said this should include consideration of intensive, residential therapy and, potentially, drugs.
Australia’s first residential recovery centre for people with an eating disorder was built this year on Queensland’s Sunshine Coast but the Butterfly Foundation is still raising funds to open it. There is already a waiting list of 200 people.
Dr Louisa Hoey, a clinical psychologist who consults almost exclusively with people with eating disorders at the Health Psychology Centre in Kew, said there was a two to three-month waiting list for new patients.
She said one of the biggest factors behind the surge in new diagnoses was the loss of social, work and school activities through the pandemic which normally help keep eating disorders in check.
“That structure not being there has been overwhelming for people,’’ she says. “People talked about just feeling suffocated at home.’’
Claire Finkelstein, who works as part of a team of psychologists and dietitians specialising in eating disorders at the Nourish, Nature, Thrive clinics in Ivanhoe and Mornington said her books had been closed to new patients for all but one week this year.
Patrick McGorry.Credit:Luis Enrique Ascui
“Prior to the pandemic we were already having huge trouble in finding clinicians who wanted to work in this field or had this skill set,’’ she said. “The treatments we have can be quite effective if they are delivered early. That is really hard to do when there is a bottleneck in the system. That is the tragedy of what is happening at the moment.’’
Ms Morgan specialised in eating disorders before she was appointed to the National Mental Health Commission. She said that where they were previously treated as behavioural problems, they are now understood to be a genetic, neurological disorder.
People who experience eating disorders are born with genomic markers. Once these markers are triggered, they are not easily “turned off’’ and can significantly alter neural pathways in the brain. This can lead to self-destructive eating behaviour and potentially life-threatening physical and mental health conditions.
There are three specified eating disorders: anorexia, bulimia and binge eating disorder. They are predominantly diagnosed in children between the ages of 10 and 18. Boys represent up to 25 per cent of diagnosed cases.
Eating disorders are particularly dangerous form of mental illness. They can progress rapidly and are associated with high mortality rates, including a 32-fold increased risk of suicide.
For young people who carried a genetic marker for eating disorders into the pandemic, Melbourne’s lockdown was fraught. Stress, anxiety, loss of control and dislocation from friends, school and normal life are all potential triggers for disordered eating.
For those already diagnosed or recovering from eating disorders, our long COVID winter was equally challenging.
“It has taken away their capacity to balance their lives,’’ Ms Morgan said. “For all of us that causes anxiety and distress. For somebody with the psychopathology of an eating disorder it is horror on steroids.’’
Sarah, a part-time student in her early 30s, first experienced bulimia and binge eating as a teenager. She said she had recovered in recent years but the stress and isolation of lockdown caused a relapse of binge eating, which is when people uncontrollably eat and don’t purge.
“The biggest risk was being at home all the time, trying to find things to do, using food as a way of occupying time and not having those normal distractions,’’ she says.
“This was the first challenging event I had to deal with in my recovery and that triggered some things inside me.”
The pandemic supercharged an already growing demand for treatments for eating disorders. In November last year, the federal government introduced its Eating Disorder Management Plan. This is an addition to the Medicare Benefits Scheme which allows people diagnosed with an eating disorder to receive rebates for up to 40 psychological treatments and 20 dietetic services a year.
In response to the pandemic, the federal and Victorian governments jointly established and staffed 15 “HeadtoHelp’’ clinics in Victoria to triage mental health problems, including eating disorders, which emerged during lockdown.
The National Mental Health Commission under a data sharing arrangement with the states receives figures from all jurisdictions on demand for mental health services, hospital admissions, emergency presentations and suicides. Ms Morgan said that within a broader surge of demand for all mental health services, eating disorders represented the sharpest spike.
Eating Disorders Victoria chief executive Belinda Caldwell said the number of children in hospital with a medical complication doubled during Melbourne’s four-month lockdown. The number of new diagnoses and relapsed cases forced EDV to close its private treatment clinic to new patients for nearly five months.
Ms Caldwell said there was currently a delay of between six to eight weeks between diagnosis and treatment. “That doesn’t sound much but if you have a kid who is losing a kilo a week that’s the difference between remaining at home or being an admission to hospital,’’ she said. “For young people in particular, prompt treatment is crucial.’’
Ms Caldwell said services specialising in eating disorders had reported a significant increase in cases among both year 7 and year 12 students. She said high achievers, athletes who played high-level sport and those with a tendency towards perfectionism were particularly susceptible.
“They like a lot of structure and don’t tolerate uncertainty,’’ she said. “The whole COVID scenario blew that out of the water.’’
Butterfly Foundation 1800 33 4673; Lifeline 131 114
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