Milton Dick (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Goldstein proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The need for the Government to urgently address the rise and treatment of eating disorders among young people.

I call upon those honourable members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places—

Zoe Daniel (Goldstein, Independent) Share this | Link to this | Hansard source

I have had mothers from Goldstein on the phone and in my office asking me to do something before their children die. Today I rise in this House to tell the story of these parents and their children. Since the start of the COVID-19 pandemic the Monash Medical Centre, for example, has seen demand for eating disorder treatment increase by 85 per cent, with no additional full-time staff to cater for this increase. Jacinta Coleman, the head of adolescent medicine at Monash, said, 'I have never, in my life, seen anything like it.'

In Goldstein, when Jo's 15-year-old daughter was diagnosed with anorexia in 2021 her family was told that this would be the most horrific journey they would go on. Jo told me, 'It's soul-destroying to watch your child be possessed by this illness, their body and mind fade away in front of you.'

It's hard to hold onto hope when the system is so poorly equipped to treat this epidemic. Specialists ED wards urgently stabilise and renourish sufferers. They are not geared to equip patients or families with support on how to treat and support the patient when discharged, which leads to a revolving door of admissions, often lasting years. The stress on families is relentless.

Eleven-year-old Esther suddenly developed anorexia this year. She has had 17 hospital admissions at Monash Children's Hospital over the past nine months—17. The unit is only for acute medical stabilisation, so Esther arrives close to death each time, otherwise she is turned away. She is then force-fed and tube-fed if she can't consume a meal before a timer rings. Her family has lost count of how many times she has been held down and 'tubed'. Can you imagine the cumulative impact of this? Esther is now so scared of food that she is entirely unable to eat at home.

Sixteen-year-old Izzy has had anorexia for four years. She says her illness has taken away almost all of the good things in her life—her sport, her friends and her school. When she goes back to hospital it's like a walk of shame. 'We're treated like criminals,' she told me. These are stories of heartbreak, and families are at breaking point.

Around one million, or four per cent of Australians, have an eating disorder, but eating disorders, when combined with disordered eating, are estimated to affect 16.3 per cent of the population. Those most at risk are adolescents 12 to 17 years of age, but they're getting younger. In south-east Melbourne the Alfred Child and Youth Mental Health Service, the Australian Research Council and Monash hospital, as well as private clinics, estimate prevalence at being almost one in nine adolescents. Some estimate that in my bayside electorate it could be as high as one in seven and heading towards one in five. I hear stories of girls not eating their school lunch and adolescents sneering at their peers for eating bread. They're competing on social platforms like TikTok on who can consume the lowest number of calories within a day or a week.

When I held an eating disorder round table in my electorate with families and experts to try to work out the best way forward, the group was extremely critical of the current landscape. We were told that GPs are inadequately trained to treat the illness or whom to refer the patient to. Precious time was wasted waiting for appointments with specialists, with no transparency around availability of services or expertise. The round table agreed that a circuit breaker is needed to stop the repeat hospital admissions and stress. The favoured approach is hub and spoke, a one-stop shop where all clinicians are located, including recovery coaches, with a three-week residential program where the mental and physical aspects of the disorder are treated concurrently. Step-down day patient care would follow, along with at-home eating disorder support to assist with refeeding. Specialists told us this variation to the standard model of care would save lives.

I've spoken to the Victorian Premier, Daniel Andrews, about the urgent need for a new model of care, and I've met with the federal minister, Mark Butler. Both agree that the current landscape is failing Australian families, but they haven't committed to a new approach. The previous federal government allocated funding to the states to build eating disorder residential centres, but the status of the centre in Victoria and others is unclear. We can't keep going around in circles. Mothers in Goldstein are pleading with me to do something before their children die of starvation. As Jess said to me recently about her daughter, 'Zoe, I'm not sure she will last until the New Year, let alone longer.' We must act.

Andrew Wallace (Fisher, Liberal National Party) Share this | Link to this | Hansard source

I'm very passionate about this issue. When we were in government in this place, under the leadership of the former Minister for Health, Greg Hunt, we did an exceptional amount of work. This is an incredibly important issue. Within eating disorders, anorexia nervosa has the highest mortality rate. Organisations like Butterfly Foundation estimate that around a million Australians have eating disorders or disordered eating. I'm very pleased to say that when we were in government we established the first residential eating disorder facility in Australia and we provided some $70 million to construct eating disorder facilities right around this country, so I say to the crossbench, the member for Goldstein and members opposite that with that $70 million we provided when we were in government to the six state governments—'Here's $70 million; go and build yourselves a residential eating disorder facility' like the one that we built in my electorate—not one of those states has provided a residential eating disorder facility, apart from what we did in Queensland, and that's no thanks to the Queensland state government; that's thanks to Mark Forbes, endED and the Butterfly Foundation, who actually got off their backsides and built it. In Queensland, we are now treating people from across the country who can't get treated anywhere else because the states in this country are leaving children and sufferers of eating disorders and their families with nothing.

I have walked this walk for almost 20 years, personally. There is no greater pain for a parent than to see your child go through an eating disorder. One has nearly cost my daughter her life on numerous occasions. We are failing children and families across this country, still—even with the amount of money that we are putting into this problem. We have got to do better.

Some will say that this is the purview of the states, and it kind of is. I thank the new federal government for keeping the $20 million that we allocated in our budget for community services like endEd in my electorate, to provide that step-up, step-down care. But we really need to do so much better. We don't know what causes eating disorders. Some doctors out there will tell you that we do. Let me tell you: we don't. We don't know what causes them; we don't know how to fix them. We're providing some funding into the research, but, if there was any other form of illness that was impacting on a million lives in Australia, we'd be pumping a hell of a lot more money into it than what we do now.

I've spoken with the assistant minister, and I believe that she genuinely cares about this. I'm going to keep working with her. And I encourage the member for Goldstein. I'm happy to talk to her about this issue. I want to acknowledge the former assistant minister for mental health, David Coleman, who has done a great amount of work in the space, as did Greg Hunt. Please, members, we need to do better in this space. There are families out there that are literally tearing themselves apart over the losses that are occurring. So, government, let's do more. (Time expired)

Emma McBride (Dobell, Australian Labor Party, Assistant Minister for Mental Health and Suicide Prevention) Share this | Link to this | Hansard source

I want to acknowledge and recognise the member for Goldstein for her advocacy and for putting eating disorders forward as a matter of public importance today. I want to thank, individually, the many members of parliament who have raised this important issue with Minister Butler and me. I notice the former minister is in the chamber now, and I want to acknowledge his efforts and contribution to progressing this cause, as well as those of the member for Wentworth, the member for Fisher, the member for Macarthur and the member for Higgins and others.

Our government is taking a collaborative approach to mental health and suicide prevention. We intend to work closely with all members and senators who are committed to seeing the change that we all want to realise. This issue is beyond one term of parliament, beyond one level of government, beyond one individual and beyond one policy. Today, I reaffirm my commitment to work with genuine collaboration in a multipartisan effort to be able to improve the lives of those living with eating disorders and those who love them. I did have a chance to meet with the member for Fisher, where he shared his own personal experience. Before I go on, I want to acknowledge all of those in the chamber and all of those who are listening who have a lived or living experience of eating disorders.

Since becoming the Assistant Minister for Mental Health and Suicide Prevention, I have listened widely to better understand the lived and living experience of people with eating disorders and of those who love them; the current treatment access, options and availability; the research; and the best evidence. I've met with the National Eating Disorders Collaboration, the InsideOut Institute, Dietitians Australia and the Butterfly Foundation, and I've had the chance to present to the Australia & New Zealand Academy for Eating Disorders.

As many of us in this chamber know, eating disorders are serious, complex and often misunderstood. Our government is determined to improve outcomes for people living with eating disorders and those who love and support them. We're working to provide early, effective, evidence based treatment options, helping to reduce stigma and supporting highly trained healthcare professionals to reduce the number of people affected by eating disorders. We know that, together, we all must do more.

Historically, eating disorders have received the lowest research dollar spend of any mental health condition. Sadly, people with lived experience continue to say that access to care and support is patchy, inconsistent, difficult to navigate, often not evidence based and, at worst, harmful. Eating disorders are biological, psychological and sociocultural, and risk factors include low self-esteem, body dissatisfaction and weight loss behaviours. While this makes recovery difficult, full recovery is possible with timely and appropriate care.

Recently, I joined the state minister, Bronnie Taylor, at the launch of the InsideOut Institute at the Charles Perkins Centre in Sydney. There we met with someone with lived experience, who spoke about their recovery, what their life is like now and what they expected their life to be. This should be the experience rather than the exception for everyone with eating disorders.

It is important that we have a full understanding of what eating disorders are and who they impact. While it's true that the highest period of risk for eating disorders is for 12- to 25-year-olds and that the group most at risk is young women, eating disorders can affect anyone, no matter their size, shape, age, ability, gender identity, sexuality, cultural or ethnic background, economic status or profession.

As I said, eating disorders are some of the most misunderstood mental health conditions. Eating disorders present both in men and in women from all walks of life and from all parts of Australia, in the young and the old. Despite assumptions to the contrary, males make up approximately 25 per cent of people with anorexia nervosa or bulimia and 40 per cent of people with binge eating disorders.

We also know that certain activities such as sports, including rowing and gymnastics, and occupations such as the performing arts leave people at greater risk of developing an eating disorder. Yesterday I spoke to a medical research scientist from Victoria whose daughter is a dancer. She was very concerned about the environment that she is training and working in and her future workplace.

Too often, eating disorders are not treated with the seriousness that they require. They're often incorrectly mischaracterised as a phase, a behaviour or a lifestyle choice. Eating disorders are more prevalent amongst people who have other forms of physical or mental illness or who are in a period of distress or increased stress. Many people experiencing eating disorders also have experienced or lived with depression or anxiety, with rates for anorexia 32 times higher than the general population. Eating disorders have one of the highest mortality rates of any mental health condition, with almost 450 people with anorexia nervosa and 200 people with bulimia nervosa estimated to die each year in Australia. They are most lethal of any mental health conditions.

Additionally, untreated eating disorders leave people at greater risk of other health issues, including suicidal ideation and completed suicide. I met with a mother last week who was recently bereaved by suicide and who, as with many of the parents that you have spoken to, is increasingly distressed about the lack of access to care and support and the lack of timely intervention. This person had increasing concerns about what that meant for them and their daughter, for her friends and for people in communities across Australia.

We know that around a million Australians have an eating disorder and around 70 per cent of people with an eating disorder will not receive treatment. Even fewer receive evidence based treatment or support. In Australia today there are estimated to be 25,000 people living with anorexia nervosa, 100,000 people living with bulimia nervosa, 500,000 people living with binge eating disorder and 350,000 living with other forms of eating disorders. Eating disorders have been pointed out as being on the rise. The Butterfly Foundation, well known to many people in the chamber, are a national charity for all Australians impacted by eating disorders and body image issues and for their families and friends. They reported a 68 per cent increase in calls to the national helpline in 2020-21 compared to 2018-19. The Royal Children's Hospital in Melbourne had a 63 per cent increase in presentations to the eating disorders service in 2020 compared to 2017 and 2019.

As a young person in my first year at the University of Sydney, a very good friend of mine—an athlete, an academic, an incredibly capable young woman—was diagnosed with an eating disorder. I visited her in the clinic at the Royal Prince Alfred Hospital. Her family were far away, on the border near Queensland. I was also able, on her first gate leave, to take her into Newtown for a meal. The impact that her eating disorder has had across her life is of the same severity that we see has impacted so many individuals and families. I reaffirm my commitment to the member for Fisher, and to all those members who care and want to do something about it, that we will work together with you. This is a genuine collaboration. This is something that, as individuals, as a parliament and as a society we must do better on. As I mentioned at the beginning, this is beyond a level of government and a term of parliament; this is something we all must work together on to be able to advance and make progress. This is something that I know that we are all committed to do. What does make me hopeful and the reason I am optimistic is the discussion we are having in the House today, and the number of individual members that have raised this with me, and with Minister Butler, who care, who know that it matters and who are determined to do something about it.

I've met with the member for Fisher and others about this, and I had the pleasure of opening the InsideOut Institute, which had $13 million of Commonwealth funding. This is at the Charles Perkins Centre at the University of Sydney, and it will help us understand the evidence base and grow the understanding so that evidence-based interventions are translated into practice. It's something I know we are all determined to see. At another time the director of the institute, Associate Professor Sarah Maguire, said it 'aims to transform how we support, treat, and even cure people with eating disorders'. The government has committed $20 million for community based eating-disorder support, and this project has been facilitated through the National Eating Disorders Collaboration. I met with Dr Beth Shelton, the National Director of NEDC, who emphasised how crucial this funding is to assist people who are developing eating disorders in the first six to 12 months—before they end up in the hospital system, which is what we all want to avoid.

I thank the member for Goldstein for raising this Matter of Public Importance today. I echo the sentiment of the Minister for health—thank you for your advocacy. To all those members determined to see the change, we will work with you to make this happen. (Time expired)

Monique Ryan (Kooyong, Independent) Share this | Link to this | Hansard source

While the COVID-19 pandemic has affected the population's mental health globally, it has had a particularly severe affect on people—especially children—who are at risk of eating disorders. All available studies in Australia, Europe and North America have identified a marked increase in the incidence and severity of disordered eating conditions since the start of the COVID-19 pandemic. Although data is limited, health professionals in Victoria, as my colleague from Goldstein has mentioned, have estimated that as many as one in nine adolescents have disordered eating or a diagnosable eating disorder. Unfortunately, because of the limited funding for research within this area of mental health, we can't be entirely sure how pervasive this problem really is.

The elements contributing to the development of an eating disorder are complex. Exposure to social media from a young age, with peer pressure to conform to unrealistic ideals of thinness and appearance, have increased the prevalence of disordered eating and the resulting eating disorders. While these were on the rise before COVID, the pandemic has made these things much, much worse. Why? It's a combination of things: social isolation, disrupted routines, family stress, interruption of sport and recreational activities, food insecurity, fear of contagion, and increased use of screens for school and for social interactions. Those most at risk are children and adolescents who are entering social and biological transition periods—typically, those aged 12 to 17. Females are more commonly affected than males, but boys are also at risk—in fact, increasingly so.

Our children are victims of unrealistic images to which they're exposed on social and mainstream media, and sometimes in vicious peer comparisons. This risk is exacerbated in those with perfectionism or compulsive personality traits and in kids with a history of family or social trauma, low self-worth and forms of weight shaming. Other mental health issues or medical problems make it worse. These conditions can cluster in school groups, often in schools from higher socioeconomic environments. The significance of these conditions is clear, but their treatment is problematic. Most GPs are unfamiliar with best-practice management of eating disorders, and the funding models and schedules are ill-suited to the management of complex psychosocial conditions.

Our public hospital system is poorly equipped for dealing with those with mild or moderate eating disorders. Its paradigms are based mainly on the treatment of the acutely medically unwell. Specialist beds can stabilise and renourish eating disorder patients as quickly as possible, but they are very limited. It's a shocking fact that there are only 35 designated public hospital beds for eating disorders in this country, and they do not equip patients or families with ongoing support for discharge. Outpatient programs can facilitate access to group support, but their waiting lists are long and their programs are often short and relatively inflexible. Most patients need three years or more of intensive, expensive treatment. The few private clinics which are now starting to offer a multidisciplinary approach have long waitlists, and access to them is limited to those who are wealthy enough to afford them.

We need more treatment centres. We need better and more effective evidence based management of eating disorders in Australia. We need a more comprehensive understanding of what's needed for prevention, treatment and relapse prevention. We need more support for families and carers who are bearing so much of the strain and receiving so little support. We need metropolitan and regional multidisciplinary eating disorder specific clinics and programs, which would be able to provide appropriate family based therapy and individualised prescriptions. We need a commitment from all state, territory and federal governments to fund these centres, and we need more dedicated hospital beds for those at immediate medical risk. We need enhanced nutritional and psychology resources in schools, and we need our GPs to be better equipped and supported to provide best-quality primary medical care. We owe it to our children, and to all of those who are suffering right now, to do better.

Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to this | Hansard source

I'd like to thank the member for Goldstein for raising this incredibly important issue through an MPI. I think it's very rare that we get an MPI that all sides of this House can speak to with such passion and concern. It is a very important issue. I'd like to thank the assistant minister for her contribution and the member for Fisher for his as well.

In the eighties, when I was young—a long time ago—there was a book called Puberty Blues, and we devoured this book as young people. It really highlighted the ugly pressure that young women felt to conform—the desire to fit in and be one of the crowd—and how that led to behaviour that was actually detrimental to their health and wellbeing. As I said, we devoured that book because, I think, we related to it so well. We had never seen the issues that we felt and were experiencing so explicitly expressed—that pressure to have sex, to drink, to smoke, to take drugs, to look thin and to dress in a certain way. We all felt it, but there it was in black and white and, ultimately, in a movie. We all felt it, but some felt it more than others.

I remember how that book and that film started the most amazing conversation for my generation: a conversation about young women and the pressure that they were under. Fast forward to today and, yes, there is more awareness and a better understanding—although there's still a lot to learn, as the members for Fisher and Kooyong have explained. There's a lot to learn about these conditions. There's been some advancement in support and education: we talk a lot more about gender equity and the empowerment of girls, young women and young men. Yet the pressures still exist and these conditions are still being manifested in serious mental ill health and, perhaps even more so, the physical conditions that follow.

I know it's not only societal pressures that lead to eating disorders, but we know that they do. Pressures from peer groups have gone beyond the channels that I may have had in the eighties. Social media has amplified that pressure; it's taken it to a whole new level. Cyberbullying is serious. It's so difficult to monitor and tackle. So-called influencers are presenting body images that are impossible to emulate. Consumables are pushed on our young people, and social trends change at a furious rate. It's almost impossible for them to keep up, and they are unaffordable and unattainable for so many. These make young people who can't reach these societal expectations feel inadequate, out of the mainstream and isolated. If they can't conform, it affects their health. It's not only women; young men, as we have heard, are also affected. The mental health impacts are profound, and, as members have outlined here, they contribute to issues like eating disorders, where we know physical outcomes are very serious. Social pressures are not the only cause that contributes to eating disorders, but they are a serious part of it.

It was extremely disturbing to see that eating disorders are on the rise, putting pressure on a health system that is struggling to provide care in the light of that rapid rise. As we've had from the previous speakers, there was a serious concern about the increase in incidence over COVID. I think the member for Kooyong expressed very clearly how COVID contributed to the rise in mental ill-health for our young people. It has been well documented. Evidence that psychiatric conditions have declined post COVID is welcomed but eating disorders haven't. These are complex illnesses with high mortality rates from suicide and organ failure.

The Australian government acknowledges that, whilst vast improvements to treatment have happened since the eighties, more needs to be done. But it isn't just a matter of opening beds in hospitals. Yes, that is vital, but we need a better trained and more trained workforce. We need to make sure that we have people there to care for them. We need wraparound services for people in their homes and in society. We need to deal with sexism, bullying, sexualisation and social media content and monitoring. We need to make sure our young people are resilient, have self-esteem and are believed. We need to support young people and their families.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

I rise to speak on this matter of public importance, noting that more than 1 million Australians are currently living with an eating disorder, and up to 25 per cent of people diagnosed will experience a severe and long-term eating disorder. Of Australians with eating disorders, 30,000 have anorexia nervosa, and as a result of the pandemic we know that it has increased significantly, by 63 per cent.

People with eating disorders experience high rates of conditions such as depression, anxiety disorders and, among adults, cardiovascular disease, chronic fatigue and neurological symptoms. The associated mortality rate is the highest of any mental illness, with suicide risk far greater than that for the general population.

The pathway to diagnosis and treatment is not easy. Eating disorders can only be diagnosed by a clinical psychologist or a medical professional, such as a GP, psychiatrist or paediatrician. It's impossible to get in and see a psychiatrist. Once diagnosed, there is access to an eating disorder care plan. On this plan, a patient can access vital support through up to 40 psychological treatment services and 20 dietetic visits each year subsidised by Medicare. While experts agree early support is key, only one in 10 Australians can recognise the signs and symptoms of an eating disorder.

There are solutions. We know our EDs are overwhelmed. We know that they are only taking the most severe cases. We need to properly resource our overworked emergency health professionals. I also call on the government to recognise accredited practising dietitians to be able to access and diagnose early eating disorders. Their training and credentialling demonstrates their competency, but currently only clinical psychologists or medical professionals can approve treatment funded by the Medicare Benefits Schedule. Accredited practising dietitians are trained to recognise early eating disorders, eating disorders in their early stages and those at risk of developing an eating disorder. We should therefore provide those Medicare items. Mission Australia says that young people rank their concerns, and they say that their body image is one of their greatest concerns. I'm aware of the work of Taryn Brumfitt who is helping to promote positive body imagine, and I recommend that everyone in this chamber watches the Embrace Kids movie. It's great for young people and families, and I think it starts that conversation. I'd also like to acknowledge the work of the Breakthrough Mental Health Research Foundation, the statewide eating disorder service in my home state of South Australia. Breakthrough say they're working to bring together the best clinical services and the Flinders University research team. They're currently planning but have not yet built a new eating disorders service at the Repat Health Precinct in Daw Park.

Back in the nineties I was a young woman. It was the time of Kate Moss, when we were all desperate to be thin. I'm now nearly 50, and I look at that young woman in her 20s who stood on the scales at 46 kilos and hated herself. I absolutely hated myself because I thought I was fat. I was really fortunately that I had a mum who was a social worker. She saw the early signs and that for me as a young woman my weight was one of the few things I thought I could control. You develop a relationship with food where food is the enemy. It's horrific that we're not doing enough as a nation. Young people today don't just have to just deal with superskinny models but also have to deal with social media—and it's just a nightmare for our children. I talk with mothers. I'm fortunate that we haven't experienced it in our immediate family, but other mums and dads feel so helpless. They don't know how to help their children, the baby that they nurtured from the beginning. They feel helpless in dealing with them when they have eating disorders and they're in their teens or 20s.

I would like to quickly acknowledge the work of the Butterfly Foundation. There is a national helpline. If you are listening to these speeches today and you are concerned perhaps for yourself or for someone you love or you are a teacher, it operates seven days a week from 8 am to midnight. The ED HOPE line is 1800 334673. For young people who don't like to ring, you can chat online or email at the Butterfly Foundation, so butterfly. org.au.

Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Link to 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.

Barnaby Joyce (New England, National Party, Shadow Minister for Veterans' Affairs) Share this | Link to this | Hansard source

Rarely do you get to stand on something that's very close to one's heart, but I am on this. I'd like to first of all acknowledge the member for Higgins, Dr Ananda-Rajah, and thank her for the work she has undertaken and also so many other colleagues of hers and others dealing with this mind-twisting, as a parent, issue that can unfortunately come across your life. I think the first step I saw in my having to deal with this is body image, especially girls—I won't give away the name—saying, 'I've just got to lose this part of weight; I've just got to lose that,' and you just let it brush over you. You don't worry about it. You just think it's a statement.

Then you get to the point of realisation. I know exactly where I was: at the Albert Hotel at lunchtime in Brisbane. I was watching this young girl push the food around her plate, and because you're a father and you're obtuse, you just say: 'Would you please eat it? Don't just push it around; put it in your mouth'—obviously the wrong thing to say. Then comes the realisation, as it slips and it slips, and then starts the pleading, because as parents you're not psychologists: 'Can you please eat? Do you realise what's happening?' Then there's the traumatisation of hospitalisation, then the tube-feeding, then being by someone's bed and saying to them, 'You're going to die.' This is repeated by so many parents. Then there's the bright side, the incredible psychologist doctors, who can do what you as a parent can't, and that's get inside a person's head and get to the point of trying to turn the situation around.

Later on, there's an understanding of the other things that floated in the background: the bullying, the intimidation, how cruel one person can be to another by trying to drive them into a certain process and the insidious nature of social media, which is never regulated. As you know, I wanted to go to the United States—but, unfortunately, I got COVID—for the express reason of trying to deal with this, to say to people: 'You're responsible. It's on your platform. You make money out of it. You're responsible for it. You're the person who should be paying the price.'

This is so important. The earlier you realise the problem, the better chance you have of dealing with it. The earlier you can see that and get a person to professional help, the better it is. Because you don't want to go through the issue where people can't get in a pool, because they can't regulate their body temperature or where you see people who are full of fun and full of life just destroyed by this. We have to do everything we can.

There is help—the Butterfly Foundation is one organisation that provides mental health help. We need to make sure that we train the psychologists and the psychiatrists, who have the capacity to work in the hospital system, and make parents aware, especially to instruct young girls that you can look how you want! You can be what you want. Beauty does not come online. Beauty comes from your soul, from your voice, from how you think and from your actions to make the world a better place. It is not determined by what you see online. And you are stronger than the people around you who sometimes try to play with your psyche, like a cat plays with a ball of string.

I would like to commend this and the member for Goldstein for bringing this forward. It's incredibly important. It resides on all sides of the chamber, and I hope there's a chance, if someone out there is maybe looking at their daughter or possibly their son, that this tweaks something with them, and they say, 'I'm going to do something about this right now.'

Gordon Reid (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I want to thank the member for Goldstein for raising this really important issue with the House. It is a very important issue, not just here but right throughout the community and particularly in my home electorate on the Central Coast.

Eating disorders are an extremely complex pathology, often with an unknown aetiology, and that's why medical professionals often find it quite difficult to treat eating disorders, particularly in that sub-acute, post-acute phase, as the member for Higgins was just describing only moments ago. Along with eating disorders in the acute phase, there are quite severe complications that can be often life-threatening. We look at electrolyte imbalances and cardiovascular and cardiac complications that can be life-threatening to individuals who are suffering from this illness. I want to acknowledge that this disease and the pathology of eating disorders haven't been given the attention they deserve throughout the medical community, and they haven't been given the attention they deserve across all levels of government. We need to make sure that we're discussing it in places like this and making sure it is at the front of our minds and top of our list of priorities when we discuss it at the governmental level.

Eating disorders have one of the highest mortality rates of any mental illness in Australia. The complications, as have been discussed, are severe malnutrition; electrolyte imbalances, particularly around sodium and phosphate which result in complications with the heart and brain; cardiovascular complications such as cardiomyopathy and enlarged heart; long QT syndrome which can cause arrhythmia and electrical disturbances of the heart; and bradycardia which is a slowing of the heart rate—all of which can impact a patient, not just in symptomatology but also in mortality.

Throughout Australia we have hundreds of thousands of people suffering from anorexia nervosa, bulimia nervosa, binge eating disorders—and that's only to name a few. There are quite a lot of subcategories of the eating disorders that are being treated by our psychiatry specialists across the country. I'll just explain some of the symptomatology. We look at symptoms such as anxiety and depression, but you also see things like amenorrhoea, presyncope, hair loss, skin changes, very low BMI, hypotension—low blood pressure—slow heart rate and loss of muscle mass, all of which are quite debilitating to the patient suffering from an eating disorder. It's also important to touch on the electrolyte disturbances that were discussed previously. On your electrolyte panels, you see disturbances, particularly in sodium, that I was talking about before, and leucopaenia and thrombocytopaenia—low platelets and low white blood cells—which can have an impact on a patient's immunity and that can have an impact on a patient's ability to clot if they're cut.

As a government, we are committed to early and effective intervention and treatment options for children and young adults with eating disorders. We acknowledge that more needs to be done. Like I've said before, more work needs to be undertaken to improve treatment options for individuals with or at risk of an eating disorder. Mental health presentations and conditions are at extremely high levels, particularly for eating disorders, and they only continue to rise. They really continued to rise during the pandemic, and that hasn't slowed down. The Royal Children's Hospital in Victoria saw a 63 per cent increase in presentations secondary to eating disorders. There was a 68 per cent increase in calls to the national helpline with the Butterfly Foundation. A study that was commissioned at the University of Sydney noted an 88 per cent increase in body image concerns, a 74 per cent increase in food restriction and a 66 per cent increase in binge eating. The numbers speak for themselves. It is a huge issue through our community and it really needs more attention in the medical community and across all levels of government.

That's why our commitments are so important. They've been discussed already, including $258 million to reduce the prevalence of eating disorders, increase access to care and improve eating disorder treatments. Once again I want to thank the member for Goldstein for raising this important issue and all the members who have spoken on this today. It needs to get more attention here, in the medical community and in the media so that we can continue to help people with eating disorders.

Kate Chaney (Curtin, Independent) Share this | Link to this | Hansard source

It's encouraging to hear the multiparty discussion of this issue of eating disorders today, and I'm glad to hear the government acknowledge that more needs to be done. Navigating the health system to access treatment for an eating disorder is too difficult, too expensive, too slow and ultimately not good enough.

In WA there are many young people and not so young people trying desperately to get help with eating disorders. In Perth we have one public hospital—the Perth Children's Hospital—that can treat, as inpatients, people 16 years of age or younger who present with an eating disorder. If you're older than that and suffering from an eating disorder, you must go to the emergency department at your local hospital and hope for the best. We have no eating disorder wards or inpatient units in adult public hospitals. There are no specialised care units in rural or remote parts of Western Australia.

The WA Department of Health recorded a 75 per cent increase in patients seeking help for an eating disorder through the public health system in the last few years, but, if you've built up the courage to finally seek help, there are just not many options. The director of the one private outpatient clinic in Perth told me she had waitlists of more than six months to see a specialist. This was the same for all services in Perth. In fact, there's at least a 6-month waitlist in Perth for any psychological services for children. I know many people in my electorate who are currently on waitlists for a range of issues, including ADHD, autism spectrum disorder, depression and anxiety, and eating disorders.

This is particularly concerning when we know that anorexia nervosa has the highest mortality rate of any psychiatric disorder. People die while on waitlists. For people who are suffering the self-hate associated with eating disorders, the rejection of a waitlist is deeply harmful. I spoke recently with a mother whose daughter is suffering from an eating disorder. She said:

Over the years, our daughter's treatment has included psychiatrists, psychologists and nutritionists. Despite a supportive GP and top-cover private health insurance, we've struggled to find adequate care for her in Perth. We've experienced the merry-go-round of her presenting at emergency departments and then being discharged without the necessary care or plan going forward, only for her to arrive back at emergency. Trying to access psychiatric treatment often involves incredibly long wait times … I once called 20 psychiatrists to try and find one who would see my daughter—the shortest waiting period was 6 months.

We've been navigating my daughter's illness for many years. There are no words to describe the toll it has taken on our family.

The WA government is currently seeking to improve outpatient services for adolescents, but this doesn't extend to day programs or services for over-18s. There's still much work to be done to stop people falling through the cracks.

There remains a lack of understanding about eating disorders outside of the few specialist centres, and there are not enough specialist centres for patients. Binge eating is the most common eating disorder, but it often doesn't get recognised or treated. If you don't appear to be starving, you're unlikely to be treated at a hospital. Overworked nurses struggle to understand the complexities of eating disorders. I've heard terrible stories of undertrained nurses put on duty to supervise eating disorder patients and then asking the patients for diet tips. I've also heard stories of eating disorder patients being misdiagnosed with borderline personality disorder and subsequently not being readmitted when they seek help.

So much of the pressure lands on community GPs, who, as we know, are already underresourced, overcommitted and stretched. Hospitals treat eating disorders as physical illness, but they are mental illnesses. Many people suffering an eating disorder have experienced trauma. A siloed approach between hospitals, outpatient services, day programs and GPs means these patients are falling through the cracks.

I call on the Albanese government to work collaboratively with states to identify how to address this health crisis. Specialists on the ground in WA are calling for more training and more upskilling for medical and health practitioners who are already in the system. Some federal resources have been promised for a residential service at the Peel Health Campus, but its current status is unclear. While, if it happens, it will be welcomed, it will not meet the increased need in our community. The federal government has the opportunity to take a leading role in directing resources towards best-practice, multidisciplinary services when treating eating disorders and to allocate funding to community mental health services. (Time expired)

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I'd like to thank the member for Goldstein for bringing forward this matter of public importance. I'd like to thank all the other speakers. I know that many speak from very personal involvement with patients with eating disorders, family members with eating disorders and close contact with constituents who have family members with eating disorders.

As a paediatrician, I've looked after children with eating disorders for many years. I've looked after children with a whole range of illnesses, some very severe and some fatal, but the issue of a patient with an eating disorder is far more complex than virtually any other illness that I've looked after. I've had discussions with multiple health ministers at the state and federal levels over many, many years. What I do know is that we have talked about this issue for decades. I don't doubt the goodwill of any of the previous ministers involved. I know Greg Hunt, when he was health minister, worked very hard with the member for Fisher to look at resources for managing people with eating disorders.

Unfortunately, much of what we've done in the last four or five decades has suffered from a lack of data—a lack of information and a lack of an evidence base. I've looked after a number of patients with eating disorders, some of whom, unfortunately, have died. I know that recently, during the pandemic, presentations of children with eating disorders to my local hospital and most hospitals around the country increased. The ages are getting younger. But we are still faced with a situation where the frustrations of all the clinicians involved and the frustrations of the families have not been dealt with. We need far more research into the issue of eating disorders. We need a far better ability to work out prognosis for children—and, indeed, adults—who present with eating disorders. We know that there are some risk factors. The member for Kooyong very effectively mentioned some of those risk factors. It affects those in a higher socioeconomic group; mostly females, but some males; and those with psychiatric features, such as obsessive personalities. There are some warning signs, such as weight loss; hirsutism, developing hair in inappropriate places; avoidance of family meal times; and overexercising.

We don't know exactly which children and people are most at risk of poor outcomes. The member for Robertson mentioned some of the metabolic effects of eating disorders. They certainly can be quite subtle sometimes to pick up and they can be quite dangerous to manage and require highly specialised care. There has been discussion already today about the number of beds around Australia for children and adolescents with eating disorders. It's very small. It's sometimes hard as a clinician to get a patient who is severely metabolically unwell into an inpatient bed that can deal with severe metabolic problems.

Refeeding someone who has starved themselves almost to death is not simple. People can actually die from refeeding, so putting a nasogastric tube in and feeding them enterally is not always simple. It requires very complex management of their metabolism, as the member for Robertson has already mentioned. Measuring salt and calcium balances et cetera, dealing with cardiac complications and dealing with neurological complications can be very complex.

The Albanese government, like the previous government, is committed to trying to make things better for these families. It is very destructive for the families. We need more evidence, hence the investment in the Charles Perkins Centre eating disorders unit and investment in more inpatient beds. This is a very complex issue that requires highly specialised care, long-term data collection and evidence based treatment. It is not simple. No-one that I know knows all the answers about managing a child in particular with an eating disorder.

Sharon Claydon (Newcastle, Australian Labor Party) Share this | Link to this | Hansard source

The discussion has now concluded.