Photo: 123RF
- Eating disorder patients put in medical wards due to lack of specialist services
- Poor access to vital mental health services in medical wards
- Medical patients - often elderly and extremely unwell - stranded in emergency departments because of lack of beds
- Staff feel at risk, due to lack of training and resources to deal with complex psychiatric patients
People with eating disorders who are stuck in medical wards for weeks are not getting the treatment they need - and are taking up beds desperately needed by other patients.
That's according to a paper published in The New Zealand Medical Journal on Friday, exposing the lack of specialist eating disorder units, which means medical wards are being "pressured" to take on these complex psychiatric patients without training or resources.
Lead author Dr Cindy Towns, a general physician and geriatrician at Wellington Hospital, said current practice not only violated the rights of eating disorder patients to appropriate care, it was causing delays for medical patients - and putting staff at risk for working outside their scope of practice.
"These are complex psychiatric conditions. We can medically stabilise them, but in a medical ward they have no access to psychologists - a cornerstone of treatment.
"Our nurses aren't trained [to deal with eating disorders], doctors aren't trained, and there's very little access to psychiatric services."
The shortage of specialist eating disorder units meant patients were "defaulting to hospital" for long periods, with untrained healthcare assistants tasked with the job of monitoring their food intake.
"They're medically stable, it's just seen as a safe place to put them for prolonged re-feeding. But it's a very expensive wasteful use of medical resources."
Dr Cindy Towns. Photo: Supplied
In Wellington Regional Hospital, the mean length of stay was 19.11 days, while at Hutt Hospital it was just under 30 days - more than double that of a specialist unit in Australia.
Neither hospital employed an eating disorder specialist.
Eating disorder patients were instead supposed to be under the care of consult liaison psychiatry teams.
However, their referrals had more than doubled in a decade with no increase in staffing, Towns said.
"We get frustrated that we are not getting psychiatric input but they are completely overwhelmed."
Medical patients clogging up emergency departments
Meanwhile, medical wards were also swamped.
Over winter, she and her fellow physicians started work each morning doing their rounds in the corridors of the emergency department.
"That's where our patients are. There are 10 to 20 patients waiting for medical beds every morning."
It was "an exercise in double book-keeping" to admit psychiatry patients to medical beds because of the mental health crisis and lack of eating disorder beds, she said.
"There's this perverse incentive because if you just put these patients on medical wards, they become invisible and it's 'free' because we're not funding anything.
"You're just overwhelming the services that are already there.
"We're the only specialists expected to manage our own overwhelming workload and that of another speciality, so it's really quite untenable."
Eating disorder patients sharing with dementia patients
General medicine was also the admitting service for infectious disease patients, which meant eating disorder patients were potentially exposed to other illnesses, she said.
"Acute medical wards are also unpleasant for young eating disorder patients.
"We have very few single rooms, we have a lot of dementia patients.
"We need for everyone's benefit to manage these patients in services that can meet their needs and are appropriate for them."
Doctors had been writing letters and advocating for more resources for over a decade, she said.
"We are finally speaking out because of the safety issues and the rights breaches and the pressure from the ageing workforce that we are under.
"We need to stop being invisible. We cannot use our medical services as psychiatric services. We must fund both appropriately."
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