7. HEALTH IMPLICATIONS Eating Disorders Queensland (EDQ) recognises the impact that eating disorders can have on the physical, emotional, cognitive and spiritual health of an individual.
We are aware of the serious consequences of a range of eating behaviours. It is therefore a requirement that all clients who access EDQ be involved with a medical practitioner of their choice. Medical stability is important for a range of reasons including: • • • •
To sustain life. To increase an individual’s capacity to be present and engage in treatment. To engage cognitively and therefore reduce rigid and obsession thinking. To regulate mood and emotion.
behaviours and medical stability. These relationships must be based on trust and respect to ensure clear communication when risks are identified. 50. Clients are encouraged to engage in a multidisciplinary team approach including support from carers and key support people where possible.
48. Undertake regular and ongoing assessments for client risks and respond according to organisational policies and the guidelines and ethics of the relevant professional bodies.
It is important to take a holistic view of recovery that actively seeks to provide linkages with other health professionals and carers / key supports as well as other related organisations and community services. This is particularly relevant given that therapeutic workers are not medically trained.
All eating disorders have the potential for serious health and nutritional complications86. Of all the mental health issues, eating disorders have the highest incidence of physical health related issues87.
This may include appropriate referrals for a range of practitioners including GPs, psychiatrists, dieticians, exercise physiologists in both outpatient and inpatient settings where appropriate.
Assessment and risk management occurs throughout the entire journey of recovery and includes attention to medical safety planning to reduce physical health risks and increase medical stability88. Safety plans may include verbal or written agreements and, at times, the involvement of third parties such as other health providers or family and carers.
An integrative approach is required to ensure that medical stability and nutritional and psychological treatments progress together in order to reduce the risks of recurrence, premature mortality, chronicity and physical morbidity90.
Where significant risk of harm is identified these concerns should be discussed with the client’s GP and treating team. 49. All client presentations must be responded to in a non-judgemental way. All eating disorder presentations, including a range of eating behaviours such as restriction, purging, bingeing, excessive exercise, laxative use, as well as alcohol and other drugs (AOD) use, violence, and physical and emotional health issues, must be discussed in a nonjudgemental way. The ongoing importance of the therapeutic relationship is particularly important in this regard89. The therapeutic relationship should encourage the client to be open about changes in their eating
51. Duty of care responsibilities should be balanced with transparency and open communication. Issues such as duty of care responsibilities and confidentiality must be explained to the client at initial intake, at which time a consent form should be signed by the client. It is important to provide education about the health implications of eating disorders and indicators of concern. Similarly, proactive communication with the client’s treatment team regarding the best ways of responding to and managing identified risks should occur early in the client’s involvement with the service. Clients should be supported to make informed decisions regarding their health where possible. However, there may be times when this is not possible. At these times it is important to maximise client agency while balancing the need for medical intervention.
Hay, P. et al. (2014) ‘Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for the Treatment of Eating Disorders,’ Australian and New Zealand Journal of Psychiatry, 48:11, 1-62. 87 Butterfly Foundation. (2018) Improving Access to Evidence Based Eating Disorders Treatment through Primary and Allied Health Services, Sydney: Butterfly Foundation; National Eating Disorders Collaboration (NEDC) (2020) National Practice Standards for Eating Disorders, NEDC. 88 Butterfly Foundation. (2018) Improving Access to Evidence Based Eating Disorders Treatment through Primary and Allied Health Services, Sydney: Butterfly Foundation. 89 Costin, C. (2019) ‘The Centrality of Presence and the Therapeutic Relationship in Eating Disorders’, in Seubert & Virdi eds., Trauma-Informed Approaches to Eating Disorders, Springer Publishing: New York, 45-56. 90 Butterfly Foundation. (2018) Improving Access to Evidence Based Eating Disorders Treatment through Primary and Allied Health Services, Sydney: Butterfly Foundation, pp. 2. 86
32
Clinical Guidelines
