A Deep Dive Into Australia’s Eating Disorders Care Plan

We know that eating disorders are complex and serious mental illnesses, and recognise the profound impacts they can have on the individual’s physical health, mental wellbeing, and overall quality of life.

In recognising the need for more comprehensive and intensive support, the Australian Government introduced an Eating Disorders Treatment and Management Plan as a specific Medicare Benefits Schedule (MBS) item in November 2019. This step marked the first time a mental illness had received its own dedicated MBS item numbers.

More commonly, this is referred to as an Eating Disorder Plan (EDP) or Eating Disorders Care Plan (EDCP). The EDCP is designed to provide a structured, evidence-based, best-practice model of treatment for those living with eating disorders with complex treatment needs. It offers a significantly higher level of government-supported care compared to a standard Mental Health Care Plan (MHCP).

Let’s dive into the details, and see how and EDCP impacts the treatment journey for those struggling with eating disorders in Australia.

What Does an Eating Disorders Care Plan Involve?

An EDCP provides multidisciplinary care over a 12-month period. The core components include:

• Expanded Medicare Subsidies: Eligible individuals can access up to 40 Medicare-subsidised psychological therapy sessions, and up to 20 Medicare-subsidised dietetic sessions within the 12-month period. This greatly improves accessibility to intensive treatment by providing regular contact with your treatment team.
• Coordinated Care Team: The plan covers assessment, treatment planning, regular reviews, and ongoing management for both the mental and physical health aspects of care. Care is coordinated by a medical practitioner, typically the General Practitioner (GP), and involves a team of healthcare providers. This team usually includes a GP, a psychologist or other mental health clinician, and a dietitian. In some cases, a psychiatrist or paediatrician may also be involved.
• Evidence-Based Approach: Treatment under an EDCP emphasises evidence-based therapies delivered by appropriately trained professionals. Psychological treatments can be delivered individually or in a group setting. Dietetic services must be provided by an ‘Accredited Practising Dietitian’.

Eligibility For an EDCP

The EDCP is targeted to those with a diagnosable eating disorder. Your eligibility is determined by your doctor based on specific clinical criteria outlined in the MBS Scheduling Book. Broadly speaking, eligible individuals are those with a clinical diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder (OSFED) who also meet additional complexity criteria. At the time of this writing, those diagnosed with avoidant/restrictive food intake disorder (ARFID) are currently not able to access care an EDCP.

Accessing an EDCP: Step-by-Step

The journey for accessing an EDCP can be tricky to understand. Getting started with an EDCP typically begins with a visit to a medical practitioner. Below is a simple infographic of the process involved, with details listed thereafter:

1. See your GP or Specialist: The first step is to make an appointment with your GP. If you are already under the care of a psychiatrist or paediatrician, they can also initiate the process.
2. Book a Long Appointment: It’s advisable to book a longer or double appointment, and mention that it is for an eating disorder assessment or a mental health assessment. This allows the doctor sufficient time to conduct the necessary thorough assessment. Preparing notes on your symptoms and concerns beforehand can also be helpful.
3. Assessment and Plan Formulation: The GP (or specialist) will assess your eligibility based on the clinical criteria. If you are found eligible, they will create a written Eating Disorder Treatment and Management Plan. This plan will include their opinion on your diagnosis, as well as treatment plan and goals.
4. Referrals to Treatment Providers: Once the plan is developed, the GP will provide you with referrals to the allied health professionals listed in the plan (usually a psychologist and dietitian). If they don’t provide you with such options, you can also seek out your own eating-disorders-informed allied professionals who you feel comfortable engaging with.
5. Ongoing Review and Follow-up: The EDCP includes a structured review process, requiring you to engage with certain team members at certain key session marks. This includes engaging with your GP for a normal review at the 10^th, 20^th, and 30^th psychology session mark, as well as a separate review with your specialist (psychiatrist/ paediatrician) at the 20^th session. This specialist review is necessary to access the full 40 sessions; without it, you are limited to the initial 20 sessions only. The managing GP practitioner should refer you for this specialist review early on in the treatment process to avoid delays in accessing ongoing treatment.
6. Treatment Provider Reports: Treatment providers are required to provide reports to the referring medical practitioner after each course of treatment, typically every 10 psychological sessions. This information will allow your GP to monitor your medical status throughout treatment and make necessary adjustments as needed.

The EDCP is a year-long plan. After the initial 12 months, you require a new EDCP to continue accessing subsidised dietetic and psychological services.

What Specific Services are Covered Under a Medicare Eating Disorder Plan?

An EDCP can include up to 20 Medicare-subsidised sessions with a dietitian and up to 40 sessions with a mental health clinician (such as a clinical psychologist, psychologist, social worker, or occupational therapist) over a 12-month period. The plan is designed to cover both mental health and dietetic treatment for the eating disorder.

Can I Have an EDP and Another Medicare Plan Simultaneously?

Generally, if you have sessions remaining on a Mental Health Care Plan (MHCP) under Medicare, you are required to use those sessions before starting an EDCP. The sessions used under a MHCP will count towards the total of 40 psychological treatment sessions allowed within the 12-month period of the EDCP. Your GP will manage the details of overlapping plans.

What If I Am Not Eligible For an EDP?

If your GP determines you are not eligible for an EDCP based on the criteria, it does not mean your struggles are not serious. It may relate to technical criteria. Your GP can still potentially prescribe you a standard Mental Health Care Plan for psychological therapy, as well as a Chronic Disease Management (CDM) plan for dietitian sessions, allowing you to access some Medicare-supported care. You also have the right to seek a second opinion, particularly from a GP or practitioner with more expertise and experience in eating disorders.

Practical Advice and Support

Navigating the healthcare system and accessing an EDCP can feel complex, especially when dealing with an eating disorder. Here are some practical tips designed to help simplify the proves and support you on your journey:

• Reach out early: If you suspect an eating disorder, contact a GP as soon as possible. Early intervention is crucial, and you don’t need to feel “sick enough” to seek help – any level of concern is valid.
• Prepare for your GP visit: Write down your symptoms, behaviours, concerns, and any physical issues to ensure you cover everything. Be honest; doctors are there to help.
• Plan Financially: While Medicare rebates help, there may still be out-of-pocket costs. Discuss fees with providers upfront. Register for the Medicare Safety Net to potentially receive higher rebates after a certain threshold. Explore other potential financial supports like Centrelink benefits or charity hardship funds if needed.
• Utilise Support Organisations: Organisations like the Butterfly Foundation and the National Eating Disorders Collaboration (NEDC) are invaluable resources. The Butterfly Foundation provides free support, counselling, practical guidance on treatment options, and help finding services. They also have a referral database of screened professionals. NEDC works to support a nationally consistent approach to care. State-based organisations like Eating Disorders Victoria (EDV) and Eating Disorders Families Australia (EDFA), which supports families and carers, also offer crucial support and resources.
• Be Patient: Recovery is a non-linear journey. Utilise the full number of sessions available under your plan, even if you start feeling better. Often, relapses can happen quite suddenly and rapidly. Also, if you’re not seeing sufficient improvement overall, discuss the next steps with your treating team, which might involve another EDCP, or more intensive care. Stay in close contact with your GP as your care coordinator.
• Maintain Hope: Recovery is absolutely possible with the right support. The EDCP is a valuable tool to access this support, as recovery can be a lengthy and slow process for some. Be open and share with your treatment team if your motivation for engaging in treatment is struggling.

Conclusion

Australia’s Eating Disorders Care Plan (EDCP) represents a significant step forward in providing accessible, comprehensive treatment for eating disorders in Australia. Understanding the plan’s structure, how to access it, and the supporting resources available can empower individuals and families to navigate the path towards recovery successfully. It ensures that structured and intensive treatment is available to all who struggle with such conditions, and ensures no one has to face it alone.

If you, or someone you know, is struggling with an eating disorder – consider reaching out to Reverence Recovery. We specialise in supporting individuals facing such complex challenges with dignity and clinical expertise.