Concerns over new eating disorder service for children

A long-running squabble over who should run a specialised statewide service for children with eating disorders has finally been resolved – but there are concerns from within SA Health’s own advisory group that the governance structure has been “botched”.

Feb 25, 2021, updated Feb 25, 2021
Photo: Tony Lewis/InDaily

Photo: Tony Lewis/InDaily

As reported by InDaily last month, the Paediatric Eating Disorder Service had stalled amid an internal dispute between health chiefs about who should oversee it.

But a model of care has now been finalised and it includes a multi-tiered governance structure, despite advocates calling for a “one-stop shop”.

In the lead-up to the last election, the Liberal Party promised to establish a “dedicated and well-resourced paediatric eating disorder service” and pledged a million dollars a year to operate it.

But a trail of emails and department documents, released to the Opposition under Freedom of Information laws, showed infighting between the Women’s and Children’s Health Network (WCHN) and Southern Adelaide Local Health Network (SALHN) about how the service should be run and who should oversee it.

An independent review in 2018 of existing services – offered at various locations including the Women’s and Children’s Hospital and Flinders Medical Centre – found the system was “fragmented”.

The model of care document for the new service says it’s been developed “to address the identified gaps in paediatric eating disorder care in South Australia”.

The document, dated December 2020 and seen by InDaily, says it was co-designed by people with lived experience and carers who wanted a “one-stop shop” approach to eating disorder care, for all ages, “to reduce age as a barrier to accessing care”.

Significantly, it “acknowledges health outcomes differ according to postcode and socio-economic factors”, adding that “for rural and remote families, disadvantage can be significant”.

It was silent on a governance structure though, saying “discussions” were “ongoing and yet to be confirmed”.

But an update notice sent to advisory group and governance committee members earlier this month said “we are pleased to announce a collaborative and integrated governance solution”.

The letter, signed by by WCHN chief executive Lindsey Gough and SALHN acting chief executive David Morris, said the new structure includes:

  • WCHN having clinical governance of outpatient services for children under 15
  • SALHN having governance of outpatient services for patients over 18
  • An integrated governance of the service delivery for patients aged 15 to 18
  • Governance of paediatric eating disorder inpatients remaining unchanged and with 
respective local health networks

That’s despite the earlier document stating that the majority of those recently surveyed wanted a “whole of life service”, and that it was problematic for patients to have to change services once they turned 18.

“These themes were communicated to the Advisory Group and Governance Committee and were pivotal in the development of the model of care,” it stated.

Mario Corena, who lost his daughter to suicide five years ago after a lengthy battle with mental health problems and an eating disorder, sat on the model of care advisory group and governance committee.

He told InDaily the governance structure had been “botched” and said he was particularly concerned about the “integrated governance” of a new 15 to 18-year-old cohort.

“It’s made it more complicated than it should be,” he said.

“It was bad enough before and now they have made it even more confusing.

“Where do the 15 to 18 year olds go? Do they go to the WCHN? Do they go to SALHN? Where do they go? And who’s going to be held accountable for the 15 to 18 year olds?”

Corena said it wasn’t the “one-stop shop” families had been calling for.

Opposition health spokesperson Chris Picton described it as “a halfway house, which wasn’t what anybody was suggesting”.

“I think there’s real concerns being expressed that this is a muddle and halfway house which is being designed to address the bureaucratic logjam that our services were in,” he said.

“Now to splice it even more by creating a third different service is potentially going to be even more confusing and difficult to navigate for these young people and their families.

“All of this process has just delayed things even more, particularly when we know the need is increasing and that the services are desperately needed by lots of families.”

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Picton said the “three different sets of services being provided” was a solution for which nobody had advocated.

“Certainly what we’re hearing is this was being done because of the impasse and the bureaucratic fight there was about this service,” he said.

“Hopefully this new service across the three different segments does work but it’s certainly something where clinicians and consumers are raising concerns as to how this came about.”

The model of care document says “patients, carers, families, professionals and anyone in South Australia with a need for eating disorder related assistance will be able to call one phone number to connect with the central referral point”.

“This will be an integrated, all ages contact point. Callers will speak to an intake clinician. Paediatric expertise will be incorporated at this central point.

“Intake clinicians will work collaboratively to ensure rapid response and actioning of all referrals and enquiries received, with paediatric and medically compromised referrals prioritised.”

It says “there will be no wrong door, with all people making contact receiving a service”.

“Pathways for self-referral will be in place.

“The central referral point is supported by a statewide, all ages, eating disorder specific website with comprehensive resources and tools for patients, families and clinicians.”

An SA Health spokesperson said in a statement to InDaily: “The new Statewide Paediatric Eating Disorder Service Model of Care will ensure we continue to provide the best care and outcomes for children, adolescents and families experiencing an eating disorder in South Australia.”

An Adelaide woman whose sister has battled an eating disorder for more than a decade told InDaily there just weren’t enough services.

Her sister has received treatment at the Women’s and Children’s Hospital, Flinders Medical Centre and a day patient program at Brighton.

She said there were often long wait lists for treatment at these services.

The State Government has pledged to build a purpose-built eating disorder centre at the Repat, including “non-residential and residential day support”.

The woman, who has asked not to be named to protect her sister’s identity, has been trying to find out more information about the facility and when it will open.

She received an email from the Statewide Eating Disorder Service at Brighton advising her that the planned residential facility for the Repat was still at least 18 months away and “we know from experience that there may be unforeseen delays to factor in”.

She told InDaily “we can’t afford to wait 18 months”.

“When the people with an eating disorder finally admit they have an eating disorder, there’s not enough help for them,” she said.

“I want the government to really realise how serious this mental illness is. It’s one of the deadliest mental illnesses.”

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