F.E.A.S.T's Around The Dinner Table forum

Welcome to F.E.A.S.T's Around The Dinner Table forum. This is a free service provided for parents of those suffering from eating disorders. It is moderated by kind, experienced, parent caregivers trained to guide you in how to use the forum and how to find resources to help you support your family member. This forum is for parents of patients with all eating disorder diagnoses, all ages, around the world.

Join these conversations already in progress:
• Road To Recovery - Stories of Hope
• Events for Parents and Caregivers Around the World
• Free F.E.A.S.T Conference Videos

Visit the F.E.A.S.T website for information and support.

If you need help using the forum please reach out to one of the moderators (listed below), or email us at bronwen@feast-ed.org.

Torie
Even after all this time one the forum and the vast number of posts I have read, I still get confused about the treatment options that exist in various countries.   One result is that I sometimes make suggestions for treatment options that don't actually exist where the original poster is.  So I thought it might be helpful to have a thread that lists them.  I'll start by reposting the helpful information from FoodSupport, here:

"If your D is too ill though then re-feeding getting started in hospital or via inpatient care is the way forward. Unfortunately there is a tendency for very prolonged inpatient stays in the UK, with not a lot of clear benefit resulting. Some parents have had their child inpatient for more than a year.   I am in Australia where there is no option for inpatient stay at all for those under 16. Our system offers medical hospitalisation for instability then always discharges back home. For us the way forward was to insist that no matter what we were going to insist on working towards weight recovery, ideally following the meal plan she had been started on in hospital - no need then for negotiation. Taking her back for reassessment if she was struggling and getting her readmitted if this is what was needed. 

"I might add the nurses in hospital did not have a way to get my D to eat either. They just had an ace up their sleeve called a NG tube. D knew that if she couldn't eat in hospital then a tube would happen straight after the first missed meal. They would not/could not offer this as an option when D was home."

FoodSupport, you may be surprised to see this excerpt from your post here.  If you would like to post a different reply, I will be happy to edit this post to remove the above quotation if you would like. 

I hope others will chime in with treatment options in their part of the world. xx

-Torie
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Quote
tina72
Hi Torie,
this is a great idea and I hope I understood it the right way. If not, please correct me:

GERMANY

Treatment options here are

- IP in special ED hospitals. Doing mostly old fashioned treatment with searching for underlying issues, food diary, talking to psychotherapists and waiting for insight. Parents are not included in the program. Is in average about 3-6 months with several rounds back after relapse at home. Waiting time for a bed: normally about 3-6 months. Some few hospitals have emergency beds.

- Outpatient treatment. Doing mostly old fashioned treatment with searching for underlying issues, food diary, talking to psychotherapists and waiting for insight. Parents are not included in the program. Is in average 25 hours (means 25 weeks/45-50 minutes a week) and does lead to IP in many cases. Time to see a therapist for a first appointment: under 18 - about 6 weeks, more then 18 - about 3 months. Time to get regular OP treatment: 6-12 months.

- Being brave and do FBT alone. No FBT treatment available here at the moment, only by skype with Eva Musby for example. And the help of ATDT. But is possible and I know a lot of families now that do that. With great progress. Time to start that: NO waiting time.

Tina72
Keep feeding. There is light at the end of the tunnel.
Quote
Foodsupport_AUS
Torie wrote:
FoodSupport, you may be surprised to see this excerpt from your post here.  If you would like to post a different reply, I will be happy to edit this post to remove the above quotation if you would like. 


No problem. I was trying with the quote to illustrate that is essential when we are trying to offer assistance that we do take into account what may actually be available to someone. Even within countries of course availability will vary, and individual circumstances also vary a lot. 

I only briefly summarised adolescent care in Australia, but to expand: 

Australia has 6 states and 2 territories. Each offers slight variations in care available. We have moderate to large size capital cities but long distances between them. Country and rural areas have little to no services as 90% of us live very close to the main cities. We have government based universal insurance which means some level of health care is available for medical care free for all, and there are regionalised mental health services which also can offer free services however may not have capacity to offer this. Around half the population has some form of hospital insurance which allows access to Private hospitals although there are only a few in the major cities offering care for eating disorders and most (perhaps all) only offer care for over 16's. Those private hospitals generally only provide voluntary care. Involuntary care is provided in public inpatient mental health services, most of which don't offer eating disorder services. Public hospitals will care for those who are medically unstable (critically ill) but generally only to the point of medical stability. FBT is available through many Child and Adolescent Mental Health services (CAMHS) Access to these is localised down to the side of the road you live on. If your area does not offer this service you are out of luck. There are a few private practitioners who offer FBT - these are at full cost to the family - minimal insurance availability. 

Our personal experience was initially seen by a GP (who initially referred to a private psychologist - who said they had ED experience but didn't and a dietitian who said they didn't have ED experience and recommended someone that did). The dietitian advised urgent medical assessment, as she thought D needed immediate hospitalisation. We were referred to a hospital which ran an eating disorder service (no choice) but free, who took two weeks to see D. On assessment they recommended immediate admission but they did not have a bed. We waited three days for a hospital bed. Admitted for medical stabilisation -gained 4kg in three weeks, discharged and readmitted 4 days later as she did not eat on discharge. Emergency department visit in the interim - advised D to try harder. Stayed in for another four weeks another 4kg , stayed out one week and then readmitted again for another four weeks. You get the picture.  The hospital offered outpatient reviews and continuing medical care and assessment, all no charge. They also offered dietetic services for free. They did not offer any mental health care, or counselling for D who was suicidal - this was accessed privately with a psychiatrist (ie. mostly self funded). When referred to CAMHS at that time they could not take on D at all.  I think most people on here from Australia will have had different experiences as we all have slightly different options open to us. That being said, if your child requires hospitalisation for ED it will generally be in a publicly funded hospital and they will stay there only until medically stable. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Quote
Torie
USA: (from https://www.aroundthedinnertable.org/post/treatment-around-the-world-9892039?pid=1305919331#gsc.tab=0)

Outpatient

Eating disorder treatment can be provided on an outpatient basis by a team of a therapist, nutritionist, physician and if needed, psychiatrist or cardiologist.

Typically, an individual struggling with an eating disorder will attend appointments one to two times a week with both the therapist and the nutritionist.Often, the physician, psychiatrist and/or cardiologist may require multiple appointments too, in an effort to monitor the health of the individual.

Duration of outpatient treatment can vary from three months to seven years or longer.In most cases, a long-term treatment plan is needed and it is not unusual to spend five to seven years in counseling in order to recover from an eating disorder.

Intensive Outpatient (IOP)

The next step up in treatment from an outpatient team approach is intensive outpatient. This often occurs at a hospital or treatment facility where the individual struggling with anorexia, bulimia, binge eating disorder or compulsive overeating attends a treatment clinic two or three times a week, and gains access to all the services in one location. These services generally include counseling, nutritional therapy, group counseling and more.

Partial Hospitalization (PHP)

This is an intermediary level of care, also referred to as “day treatment.” People in partial hospitalization are in an eating disorder clinic for 6 to 10 hours per day, 5 to 7 days per week. There they receive the majority of their day’s nutrition, participate in therapy groups, and meet with their therapists, dieticians, and psychiatrists. Partial hospitalization is an alternative to residential care, allowing individuals to continue living at home and keep a foot in the real world.  Many partial hospitalization programs also have supportive housing options for individuals who do not live near the clinic.

Residential Treatment

If the two prior methods of eating disorder treatment are ineffective, then residential or inpatient treatment is recommended.This generally involves a stay at a hospital or treatment center for 30 to 90 days.

These residential eating disorder treatment centers often operate holistically and have staff and services to address the multiple needs of their patients.Art therapy, equine therapy, group counseling, individual therapy, nutrition counseling and more are typical fare at treatment centers.

Inpatient Treatment

This level of treatment offers continuum of care 24 hours a day in a hospital setting. The primary focus of this level of care is medical stabilization and interruption of weight loss, with typical stays less than 3 weeks. Once the individual is considered to be medically stable, they are usually discharged to a residential treatment center for ongoing care.

"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Quote
harmonymom
Well, I can only offer my opinion here. I am American living in Australia for the past 12 years. My daughter developed her ED in Australia and I feel the biggest difference is the amount of rehab facilities for eating disorders. In QLD where I live, there is only private pay very expensive HEALTH retreats to send those suffering ED if they need more than a GP/dietician team. It's the same for alcoholism or drug dependency. Gov funded healthcare simply doesn't cover this kind of treatment. Even if you have high cover private healthcare that you pay monthly for, they do not pay for a 30 60 90 day type of care. Fortunately, I caught my daughters ED early BUT she is only 80% per cent better AFTER 2 years! She never had to be hospitalised but only bc I was switched on and saw what she was doing ( bc I am the genetic link ). Everyone criticizes the American healthcare system, BUT at least if you are working and you have a severe ED patient, your private insurance will cover .
Quote
scaredmom
Here in my province: Ontario, Canada. Fully covered by our Provincial Health insurance (universal health coverage)
If you are with the Canadian Mental Health Association (CMHA) you will get what Torie has listed above. Other "private"ED counsellors are "Iffy" at best. There seems to be more support for the children than adults in my opinion. Generally it is FBT that is practised here with reference to the Lock books,Eva Musby and FEAST.  The tertiary hospitals and out patient teams they work with are great. Smaller communities may not have proper MDs that do ED at all. And so unless they realise they are not equipped to handle those cases, those people may not get the help they need. We have all the options, like residential etc... however, limited beds/space and not always close to home. Closest residential from me is 1 hour west and 1.5 or more hours west. 
There is a group of eating disorders clinicians in our province that do meet, and network to ensure the province is "together" with their treatment of EDs.
Here ,you can self refer to an ED clinic. Ed clinics have nurse practitioner, social workers, and dietitians, psychiatrist only to prescribe and monitor meds. 
Getting admitted to hospital is difficult- they don't get it unless they know ED. Our inpts was truly FBT. In fact they encouraged us to bring in "home food" and eat with her. 
XXX
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
Quote
debra18
I think we all should move to Canada. They look the best so far!
Quote
Kali
Great topic. Torie, thanks for starting this thread!

Kali
Food=Love
Quote
tdm13
great initiative, as parents often need a local overview of possibilities.

Regarding Switzerland, mainstream treatment is the same outdated traditional one as in Germany (see Tina's post).
Recent initiatives are however popping up:

  • In Lausanne, DISA team (part of the university hospital CHUV) has been providing in the last couple years outpatient treatment of FBT with a french twist (aka. Dr Cook Darzens). it is mainly targeted towards pre-teens and teens.
  • In Lausanne again Boston team (also part of the university hospital CHUV), is providing individual therapies to accompany FBT (i.e. not focusing on underlying causes)
  • In Geneva, Clinique Belmont is providing their own ED treatment that strongly departs from traditional ones but is still quite different than FBT (Dr. Perroud)

This is relatively poor for a large population of several millions, but it is a start and it saved our d (DISA)!
Note that Eva Musby is fluent in French and can provide guidance by phone and help kick start for others that are not near above good centers.

best to all

tdm13
___________________________.
parents of d who started to restrict food at 11yrs in Aug2015, diagnosed as AN. Hospital resident mid-Dec to mid-Apr2016 under traditional treatment (isolation+weight contract). Total failure made us  switched successfully to FBT at home. WR in Aug 2016. No more symptoms since Jan 2018, follwoing growth & bmi percentile
Quote
Torie
For NEW ZEALAND:

Here are the guidelines for Starship, which treats kids up to 15 (or 17 if you're lucky):

http://www.adhb.govt.nz/starshipclinicalguidelines/_Documents/Anorexia%20Nervosa.pdf

Thanks, HopeNZ for posting the link. 

-Torie

-
"We are angels of hope, of healing, and of light. Darkness flees from us." -YP 
Quote
wayout
harmonymom wrote:
Well, I can only offer my opinion here. I am American living in Australia for the past 12 years. My daughter developed her ED in Australia and I feel the biggest difference is the amount of rehab facilities for eating disorders. In QLD where I live, there is only private pay very expensive HEALTH retreats to send those suffering ED if they need more than a GP/dietician team. It's the same for alcoholism or drug dependency. Gov funded healthcare simply doesn't cover this kind of treatment. Even if you have high cover private healthcare that you pay monthly for, they do not pay for a 30 60 90 day type of care. Fortunately, I caught my daughters ED early BUT she is only 80% per cent better AFTER 2 years! She never had to be hospitalised but only bc I was switched on and saw what she was doing ( bc I am the genetic link ). Everyone criticizes the American healthcare system, BUT at least if you are working and you have a severe ED patient, your private insurance will cover .


I'm sorry to hear your daughter is still struggling. But I just want to share a different perspective. In Queensland there is a good public service for people 18+ - Queds based at RBWH. They have very strict guidelines for admission and patients can be IP for months in the public system whether they want to be there or not (they're pretty liberal in their use of TAs, which I believe is a good thing in many cases). I don't know much about the services in Brisbane for under 18s because my d was almost 20 when she was admitted through Queds. But there is a day program that a friend of my d's apparently did and got a lot out of, covered by medicare, and is open to patients 16+. No the services here aren't perfect, there are funding issues and long waits for beds on H floor but considering what is available I think we are lucky compared to some other states/other countries even. 
Quote
HopeNZ
I've been meaning to post on this thread, Torie, thank you for the reminder [wink]

New Zealand:

Starship is a specialised children's hospital in Auckland and it sets the standard for care of children throughout NZ, producing protocols for the care of children in various situations/with various conditions in NZ hospitals (as well as the protocol for treating children with eating disorders there are those for anaphylaxis, intensive care etc).  So although my d was on a general children's ward in a regional hospital, all nurses and medical staff were familiar with the best practice procedures for medical stability and initial refeeding of a child with and ED.  As I understand it, the Starship Protocol linked by Torie above should theoretically be applied to all children with EDs in all children's wards throughout NZ, although this does not seem necessarily to be the case.

Whether or not a child's journey starts with an inpatient stay, there appear to be a couple of pathways following diagnosis/discharge.  NZ is divided into a number of district health boards, and options seem to differ among them.  However, the nationwide government funded service is Child and Adolescent Mental Health Services.  This is the route we took following discharge back into the community.  FBT is the model for treatment through CAMHS.  Through our FBT therapist we have access to a psychiatrist, dietician etc.

I believe another route, more often taken by young adults, is ongoing support through the hospitals.  Others have also mentioned specialised ED services in different regions.  Perhaps forum members will chime in with their knowledge of other services in NZ.

Quote

        

WTadmin