Dietitians Celebrated for their role in nourishing mind, body and brain

The theme for this year’s Dietitians Week (Monday 8 - Sunday 14 April 2024) is Nourishing mind, body and brain - a dietitian can help, highlighting that mental health, physical health and wellbeing go hand in hand and need to be treated together. On top of physical benefits, studies show that seeking mental health support from a dietitian can lead to:

• Improved mood, increases of productivity, focus and less fatigue
• Reduced symptoms of anxiety, stress, depression, sleep disorders, OCD, PTSD and ADHD
• Reduced side effects from medications for psychotropic medications

Dietitians Australia is calling for nutrition experts to become recognised as crucial to mental health support teams.

Earlier this year, the Butterfly Foundation launched the second edition of ‘Paying the Price’ in partnership with Deloitte. The comprehensive report, released more than a decade after the first edition in 2012, reveals the ongoing and devastating economic and social impacts of eating disorders in Australia and highlights the urgent need for action.

The PHN would like to highlight the important role local dietitians make to people’s wellbeing here across our own region.

Thank you to Jodie Sheraton and Bronte Willianson for sharing their thoughts and experience this Dietitians Week.

Jodie Sheraton, Director and Accredited Practicing Dietitian at Myrtle Oak Clinic and Optimum Intake Dietitians on the Central Coast

Eating disorders are serious and complex mental illnesses with psychological, physiological, and nutritional factors. We have seen a growing need in our local area for eating disorder treatment through an increase in the range of eating disorder presentations, an increase in binge eating disorder and Avoidant/Restrictive Food Intake Disorder, alongside anorexia nervosa and bulimia nervosa.

At Myrtle Oak Clinic, our Clinicians receive evidence-based training for eating disorders irrespective of their standard qualifications as a psychologist or dietitian. Many of them have received the ANZAED Eating Disorder Credential.

Utilising the Case Conferencing Medicare item numbers, we liaise with the client’s GP to ensure a streamlined approach to communication and collaboration, and family members are encouraged to be included in the support of an individual in treatment where appropriate.

Due to the expertise of dietitians regarding the physiological and nutritional effects of eating disorders, they have an essential role in the multi-disciplinary treatment of eating disorders.

In a collaborative approach, the dietitian and mental health clinician deliver treatment concurrently according to their expertise. Psychological intervention is unlikely to be effective if nutritional repletion is not first addressed due to impaired cognitive function and psychological health.

What do dietitians need to operate more effectively in our region?

Dietitians are operating effectively when we are included in a treatment team, however we need to be included as a key member of the healthcare team. We need other health professionals to be aware of the versatility of our skills and knowledge in helping to support an individual with mental health challenges.

Recently we have seen a huge emphasis placed on early identification and access to treatment for those experiencing an eating disorder and more funding through Medicare Eating Disorder Plans, making treatment more financially accessible. The introduction of the eating disorder credentialling system is also helping to educate a wider group of clinicians including GPs to have more awareness, skills for identifying and options for referrals.

Why do you think dietitians are crucial to mental health support teams?

GPs and other referring clinicians should include a Dietitian in the Medicare Plan referral under a chronic disease management plan. Although we are currently not provided with any mental health Medicare referral item numbers, outside of the Eating Disorder Plan (EDP), if clients were able to access rebates to see a dietitian for other mental health conditions this would reduce the financial burden of seeking support from a dietitian and create greater opportunity for a wholistic approach to their mental health management.

Dietitians generally have shorter waitlists than mental health clinicians which may support timely commencement of eating disorder treatment. The involvement of a dietitian may alleviate the workload demand on mental health clinicians as a sole treatment provider.

Sessions with a dietitian currently attract a lesser Medicare rebate, this pay gap is hindering the dietetic profession. It is also not recognising the longer length session times that are required for dietitians to support a mental health client adequately and effectively. Most dietitians are conducting 45min-60min sessions where the Medicare rebate is based on a 20 min session time, leading to larger out of pocket expenses for clients.

Bronte Williamson (she/her), Managing Director & Lead Dietitian, Nourished Not Deprived, Australia Wide

Eating disorder presentations to our clinic have certainly risen and reflect the stated prevalence noted in the report. The driving forces behind this increase are multifaceted in nature. An increase in awareness may contribute to the rise in presentations, as well as the social trend of mental health advocacy that has permeated many social media platforms over the past few years.

Although awareness has increased, funding towards this subgroup of presentations has not. When compared to other noted psychiatric illnesses, the funding allocated towards research and treatment is much lower across the board. This situation is reflected by the fact that the NDIS does not fund eating disorder treatment, and Medicare only provides a portion of subsidy towards four diagnosed eating disorders, leaving out many other eating disorders with no funding or subsidy available.

In the allied health space, eating disorders represent a niche area to work in. While a multimodal approach to treatment is recommended, we seldom see appropriate referrals from GPs to qualified and well-educated psychologists, mental health occupational therapists, dietitians, or speech pathologists to assist in appropriate treatment. Depending on the type of eating disorder present, different referral needs arise.

Nourished Not Deprived operates as a highly effective multi-disciplinary team dedicated to providing comprehensive care for individuals struggling with eating disorders. Our clinicians are experts in various facets of mental and physical wellbeing, with some specialising focus on the complex realm of feeding and eating behaviours across all stages of life. This approach stems from a profoundly personal journey; having faced barriers to appropriate treatment in my childhood due to misguided BMI criteria, I resolved to establish a clinic committed to revolutionising access to care.

We pride ourselves on our 'less than a two-week wait policy' for all modalities, recognising the critical urgency in addressing psychiatric illnesses promptly. Moreover, our innovative patient-to-practitioner matching system ensures that everyone receives tailored care from the most suitable expert, optimising treatment outcomes.

Why do you think dietitians are crucial to mental health support teams?

Unfortunately, Dietitians are often inappropriately overlooked allied health professionals, yet they are, in my clinical opinion, a crucial component of mental health support teams. This stems from the fundamental understanding that proper nutrition is essential for optimal brain function. When individuals are not adequately nourished or are malnourished, their cognitive abilities, emotional regulation abilities, and capacity to engage in therapy are significantly compromised. Therefore, ensuring individuals achieve nutritional adequacy is paramount before effective therapeutic interventions can be undertaken.

What do dietitians need to operate more effectively in our region?

As a Dietitian speaking from personal experience working in the field, as a colleague hearing from my other Dietitian friends, and as a director working alongside my staff, I believe several factors are crucial. Firstly, they need to feel valued as clinicians within the healthcare system. Organisations must recognise and advocate for their necessity, providing support and resources. Dietitians require collaboration and support from a multidisciplinary team to effectively address the therapy component of behaviour change. It's essential to acknowledge that Dietitians should only be expected to be experts in some aspects of therapy. Therefore, a collaborative approach involving psychologists, occupational therapists, and other specialists is vital for comprehensive care.