"Lack of availability and support for eating disorder patients"

Dear Lil hen,

Thank you for feeding this back to Perth Children’s Hospital (PCH). We take all feedback about our services very seriously and comments received to enable us to review practice and strive to improve our care and services.

I am sorry that you feel your child struggled by not being nursed within the 8 bedded pod for patients with Eating Disorders and feels unsupported.

Last year we conducted a review of our inpatient service for patients with Eating Disorders. We modified and improved our care so that patients with Eating Disorders could receive an increased nursing ratio and be provided with meal support for 6 meals a day, 7 days a week. The data on the number of patients with Eating Disorders was analysed and resulted in 8 beds being prioritised for these patients based on admission rates. However we have had a significant increase in the number of patients requiring inpatient medical stabilisation for an Eating Disorder, and there are often occasions when there are more than 8 patients requiring admission. We endeavour to admit these patients within Ward 4A – so that if they are not able to be allocated one of the 8 beds, they still receive care from nursing staff who are skilled and trained in caring for this cohort of patients. We have committed to increasing the nurse ratio to offer similar support, and are currently in the process of recruiting more staff. We agree that restraint is a last resort and would prefer to reduce anxiety and encourage compliance to treatment through de-escalation expertise and chemical support.

You are correct in that the number of children and young people presenting with eating disorders has increased over the past year. This is in keeping with a worldwide increase in people seeking help for eating disorders which have occurred since the COVID-19 pandemic. The reasons for this require further research, but possible causes include disruption of regular eating routines and exercise regimes, increased exposure to media, and the impact of additional stressors as a result of the pandemic. Prior to COVID-19, a steady increase in mental health-related admissions has been noted over the past four years. Eating disorders are the most common diagnoses for children and adolescents admitted to hospital for mental health reasons and increased by 17.5% in 2019/20 (Source: Children’s Healthcare Australasia. https://children.wcha.asn.au/).

Where possible, our Eating Disorders Service staff try to keep children and young people out of the hospital with a range of supports in the outpatient setting, including the Day Program, regular appointments with EDS clinicians and/or weekly monitoring via the family GP. Family-Based Therapy (FBT) is the leading evidence-based treatment for eating disorders and is best delivered in an outpatient setting. We know that hospital is not the best place for young people with eating disorders to recover from their eating disorder, but may be necessary for the young person to be restored medically and receive enough nutrition to be able to think clearly, retain and process information to benefit from any therapy they engage in. Some children and young people require many medical hospital admissions as part of their treatment journey. Unfortunately, many children and young people are requiring hospital-based medical restoration currently and our medical team is best equipped to deal with this.

We continue to gather information including patient numbers to assist us in guiding our care/service so that we can ensure we are able to provide the best possible care for our patients in this challenging situation.

Kind regards,

Linda Hop

Nursing Co-Director Medical (Acting)

Perth Children’s Hospital | Child and Adolescent Health Service