Healthy Mind and Body: headspace

and Dietitians connecting to improve

the health and well-being of young

people with disordered eating in

rural NSW

Deanne Harris Dietitian HNELHD

Lisa Staples Clinical Care Coordinator,

Occupational Therapist, headspace Tamworth

Why are we presenting today?

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Eating Disorders in Australian Young People

• Eating disorders affect estimated 9% of the population.

• Eating disorders may lead to long-term social & functional

impairment

• Impact can include psychiatric, behavioural and medical

complications, social isolation and increased risk of death

• Mortality rate for eating disorders is the highest of all

psychiatric illnesses and over 12 times that of people without

an eating disorder

• 1 in 5 people with anorexia who died prematurely committed

suicide

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Eating Disorders in Australian Young People

• Adolescence is a peak period for the onset of eating disorders

• Eating disorders are the third most common chronic illness in

young females and are increasing in young males

• 2nd leading cause of mental health issues in young females

Adolescent girls who diet at a severe level are 18 times more

likely to develop an eating disorder within 6 months

• 70% of adolescent girls have body dissatisfaction

• Body dissatisfaction is one of the top issues of concern in the

2013 Mission Australia Youth Survey

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Eating Disorders in Australian Young People

• Obesity in adolescents has increased by 75%

• Co-morbid obesity and eating disorders in young people are

increasing faster than either condition alone

• One in 5 people with obesity also present with disordered

eating

“What began as a small habit slowly became an

uncontrollable addiction. While it felt like I was in fact

totally in control of my body and my life , I was in fact

totally out of control. By the time I reached 17 years of

age I was …drowning within a world I couldn’t handle”

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Why we are sharing what we do….

•Different approach to servicing young people

•Multidisciplinary team approach (dietitian, Youth Care

Coordinator, Psychologist, GP)

•Unique location and position to work with young people

in a new service and location

•Connections between the services/staff

•Outcomes

headspace

headspace

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• headspace is the National Youth Mental Health Foundation

providing early intervention mental health services to 12-25

year olds.

• Created in 2006 in response to the recognition that the

existing health system needed to be much more accessible

and effective for young people with mental and substance

use disorders

• One stop shop

headspace

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• Services are designed to make it easy as possible for a

young person and their family to get the help they need for

problems affecting their wellbeing.

• This covers four core areas: mental health, physical health,

work and study support and alcohol and other drug

services.

• By 2015 there will be a total of 90 Centres across Australia.

Our centres

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eheadspace

Other headspace National services

headspace School Support

•The service works with school communities to prepare for, respond to,

and recover from suicide

headspace Youth Early Psychosis Program

•a significant early intervention and holistic opportunity to improve the

lives of young people, and their families, who are affected by psychosis.

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headspace Tamworth

• Opened Feb 2013

• Centacare is the lead agency

• Consortium members include Local Health Network (Mental

Health Service), PCYC, Police Area Command, North West

Health, AES, A4E (Employment Providers)

• Services include Youth Care Coordinators, Allied Health

Practitioners, GP, Employment Providers, Sexual Health,

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headspace Tamworth

September 2015

37 new young people per month

392 occasions of service

56% female

42.2% male

1.7% other gender identified

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headspace Tamworth

Age range Percentage

12-14 35.1

15-17 21.6

18-20 16.2

21-23 21.6

24-25 5.4

25 0

Dietetics Department - TRRH

• Local dietitian and GP formed a partnership based on a common interest

to work with eating disorder patients in 1995

• Evolved into a local network of dietitians, psychologists and GPs who

meet monthly to provide peer support, education and case conferencing

• TRRH dietetics provides 2 days per week outpatient service for people

with eating disorders. Inpatient and outpatient Triage tool scores a

diagnosed eating disorder as category 1

• Experienced dietitian mentoring staff to increase skill mix to care for these

clients

Dietetics Department - TRRH

• Primary concern: accessing clients in very early stages of illness before

they would normally be referred to hospital outpatient service. Research

indicates best chance of full recovery if illness caught early.

• Recovery rates for adolescents in first year of illness between 74-90%

whereas 21% if history of 4 years or more

• Lead to discussions with the new local youth health service – headspace

• Needs assessment

What did we do - Needs assessment

• 2nd year dietetics students from University of Newcastle

undertook needs assessment to study expectations of clients

at headspace Tamworth regarding dietetics services

• At the time there was a general headspace dietetics service

weekly which had issues including high non – attendance and

follow up rate and required the GP to be on-site

• Examined thoughts, perspectives and knowledge of the role

of a dietitian and any barriers, concerns or misconceptions.

• Aimed to enable headspace Tamworth to tailor their dietetics

service to best suit their clients

• Surveyed clients at headspace, headspace staff and local

dietitians

Increased dietetic interventions at headspace

• TRRH dietitian participated in “Rock your mind and

body” education group with young people and Youth

Care Coordinators

• Interest in nutrition and disordered eating grew

• Staff education developed and delivered on eating

disorders in young people

• Role of the eating disorder dietitian versus general

dietitian

Implemented changes in servicing young people

• Developing education for staff on the link between mental

health and diet.

• Increasing Nutrition Awareness of Staff (Nourishing

Networks)

• Developing resources staff could distribute to their clients if

clients want to learn more but do not want see a dietitian

• Expanding the psycho-social assessment in the eating

domain

• Involving parents in education regarding food and nutrition

• Explaining the dietetic service effectively within the mental

health domain

Implemented changes in servicing young people

• Streamlining the referral process including timeliness of referrals

• Bringing the service to the young people

• Two dietetic clinics per week – one on disordered eating and the other

dealing with other nutritional concerns

• Joint appointments to maximise attendance of the young person and their

family e.g. structure of appointments, Youth Care Coordinator,

multidisciplinary approach, individualised service

• Holistic assessment and treatment

• Monthly eating care review and education session

• Developing a nutrition resource manual specific to young people

Nourishing Networks

• headspace staff all participated in Nourishing Networks

• 10 week self directed learning package and one day

workshop

• Focuses on early identification and referral/ management of

clients with all forms of disordered eating

• CPD points for professional association

• Aimed to make staff more aware to screen and be

comfortable if presented with an actual eating disorder

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Occasions of Service (2014)

Disordered Eating Service Other Dietetic Service

98 Young People over 33 weeks

2 FTA

55 Young People over 21 weeks

11 FTAs

6 Cancelled

4 groups (average of 1.5 young

people per group)

Case studies J

• J , 14 YO male referred to headspace by GP for anxiety

• When referral received, contact with the GP was made to obtain blood results

• On headspace assessment with new nutrition questions eating issues were primary concern

and major cause of anxiety

• Referral to dietitian

• On assessment dietitian contacted GP re concerns severe eating disorder

• J weight 37kg, weight had dropped 15kg in 6 months

• GP : bloods and physical examination diagnosis anorexia nervosa, referred to paediatrician

John Hunter Hospital

• Family had been trying to get help for a few months, no recognition of Eating Disorder as

young person was male

• Paediatrician worked with dietitian and psychologist at headspace for continuity

• Dietitian and psychologist joint appointments to work with J and family around all aspects of

managing the ED

• 7 months down the road J is 50kg , playing representative basketball and looking for his first

after school job

• Usually J would have seen private GP, private psychologist, hospital dietitian in 3 locations ,

across 3 medical records systems and at significant cost to the family

Case studies A

• A, 21 year old young female

• Self referred to headspace for stress and anger management, relationships

issues

• Moved out of family home at 15, period of homelessness

• 3 year old son

• Referred to dietitian for inability to gain weight

• Weight on referral 48.3kg

• A did not meet criteria for outpatient service at hospital as not physically unwell

• On assessment history of anorexia nervosa at school

• Youth Care Coordinator attended first appointment with client

• Number of joint appointments over 12 months to look at practical issues such as

budgeting, legal issues, food preparation, nutrition needs for herself and her son

• Also worked with consortium partner (AES) employment service at headspace

• After 12 months weight is 55.9kg.

• Son enrolled in preschool and A has first fulltime job as an administration trainee

Questions?

Thank you