Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Hansard source

I'd like to thank the member for Goldstein for raising the profile of this important issue and for her local advocacy. I would also like to thank other members of the chamber for sharing their testimony. There is clearly bipartisan support in the House to fix this vexed problem. What is key to fixing this problem, however, is listening—listening to the front line, in this case our constituents, about the lived experience and listening to the families who have gone through this problem. But I'm here also to share my experience as a senior clinician at the Alfred, where I was a senior generalist who managed patients with eating disorders, principally anorexia nervosa, who were at the most severe end of the spectrum. These patients were overwhelmingly female. They were sometimes children, even though the Alfred is an adult hospital. Many were in their late teens, and my oldest patient was in their 30s. These patients always came into the hospital in crisis. They were close to death because a hospital like the Alfred is not just a tertiary hospital, and so we looked over the most severe cases. I had patients who had BMIs as low as 11. To put that into context, a healthy BMI is 19 to 25, so you can just imagine what a BMI of 11 actually looks like. These women, sometimes teens, were fragile. They were fragile physically but also in their minds, and it was really, really challenging to look after these patients. It was hands-down the hardest group of patient for me and my teams to manage. Not only were they skeletal and their arms and legs were like twigs but they were always cloaked in baggy, warm clothing because they were unable to regulate their temperatures. It was very challenging to form a therapeutic alliance—that is what we strive to do as clinicians; to form a therapeutic alliance with our patients but also their families—because these patients were in the grips of this disease, and they rebuffed all attempts by us to try and make them better.

So it fell to a multidisciplinary team to try and manage them, and at the head of that was someone like me, a senior clinician who had to make the tough decisions and sometimes be the bad guy in the room. I signed off on some pretty restrictive practices, I've got to say—things like tube-feeding, sometimes mechanical restraints in order to put the tube down. We would often do blood tests, twice a day, to make sure the electrolytes were not going haywire. In some cases—actually, in all cases—we would start off with the patient just being in the ward with a standard nursing ratio, but it would always escalate to requiring a nursing special in order to watch over the patient to make sure they weren't purging surreptitiously or hyper-exercising, which happened a lot, or indeed self-harming. So it was a really difficult problem. We had daily consultant-liaison psychiatric input. Dietitians would come twice a day. We also had social workers seeing patients and their families, because often that relationship was damaged, it was fractious and it was very difficult for families to watch what was happening. They had that sense of powerlessness that they were unable to turn the ship around.

Where things went wrong actually was not in the hospital. These patients had intensive ward-based care. Sometimes despite our best efforts they would end up in intensive care. But where things often went wrong was in the transitions between hospital and the outside world. It was very difficult to find step-down care units, and that is something our government is trying to address. So we are committing over $258 million towards fixing this problem, which has been neglected, and it has been neglected basically because it's rare, because it's gendered—overwhelmingly affecting females—and because it's complex. We're really good as a health system at fixing simple things like a broken arm or a broken leg. We are really bad at fixing complex problems that require multidisciplinary care, and this is all the more reason why we are also committing $13 million towards a centre for research excellence which has already opened at Sydney University, the Charles Perkins Centre, and $20 million towards community-based eating disorder support units, the kinds of supports I never had as a doctor.

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