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[8 min read] Eating disorders: Changes to the MBS and GP care
Each year, one in five Australians adults experience a mental health disorder. In 2011, mental illness and substance use disorders accounted for 12.1 per cent of our national total disease burden – the third highest group of diseases behind cancer and cardiovascular disease.
It is difficult to quantify the contribution of eating disorders to these statistics because they are derived from national surveys of mental health in which eating disorders are neither included nor accounted for. In fact, eating disorders have been excluded from the standard processes and responses regarding mental illness for some time.
Eating disorders also attract low levels of research investment. In Australia, government funding for research into eating disorders equates to approximately $1.10 per affected individual, which is below funding for other illnesses, such as autism ($32.62 per affected individual) and schizophrenia ($67.36 per affected individual).
Eating disorders have an estimated prevalence of between four and eight per cent and they are highly comorbid with other mental health conditions.
Anorexia nervosa has one of the highest mortality rates of all mental illnesses. All clinical practice guidelines recommend treatment within a multidisciplinary team that includes a medical practitioner, a psychologist and a dietician. All available evidence-based treatments for eating disorders are delivered in the community and require somewhere between 20 and 50 sessions to bring about satisfactory remission rates.
The best available intervention for a mental health condition in most cases does not reach the person. In eating disorders, over 70 per cent receive no treatment, and of those who do, only around 20 per cent receive an evidence-based treatment.
In Australia there have been structural reasons why that evidence base is unlikely to reach the person with the illness. What has been available to people with eating disorders (and all other mental illnesses) in terms of universal community care under the Medicare Benefits Schedule (MBS) has been 10 psychological sessions, when the evidence base clearly indicates 20–50 as the effective dose.
On 1 November 2019 the federal government will start reforms to the MBS that will transform available community care for Australians living with an eating disorder. This prompts consideration of how we treat mental illness in this country in line with the evidence base.
On 1 November, eating disorders will become the first diagnostic category among mental illnesses to have their own item numbers under the MBS.
For people with anorexia nervosa, bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who meet the criteria, the new scheme will deliver 40 rebated sessions of psychological therapy, along with 20 dietetic sessions.
Regular appointments with GPs are built into the architecture of the system, and consultation with a psychiatrist and/or paediatrician is mandated. The scheme outlines minimum professional standards for delivering these services, including minimum training levels and listed evidence-based therapies.
The federal government has also funded the National Eating Disorders Collaboration to scope the credentialing of providers for these items to ensure appropriate skill within the workforce to deliver quality care.
For mental health, this redesign of the MBS system for eating disorder care is the first attempt to align the architecture of the system with the best available evidence for treating these illnesses within the community and build structures to support workforce competency.
This initiative will present other opportunities. Its focus on primary care presents a real opportunity to increase early intervention in eating disorders. This is a group of illnesses GPs find challenging to manage, partially because of the co-presenting psychological and medical acuity.
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Source: Maguire, S. (7 October 2019.) Eating disorders: aligning the MBS with evidence. MJA. Issue 39. https://insightplus.mja.com.au