Michael Higgins has dedicated the larger part of his 27-year nursing career to caring for South Australians with an eating disorder, and still finds each shift as challenging and as rewarding as the first.
“I do still struggle daily with trying to find out why someone has chosen to starve themselves,” the Registered Nurse says. “A whole lot of things come together to coalesce in an eating disorder and these can be different for each person.” It is the complexities behind the psychological illness that have kept Michael at Flinders Medical Centre’s dedicated eating disorder unit for 24 years. “The challenges and the rewards lie in ‘teasing out’ what’s happening in a particular person to help them on the road to recovery,” he says.
“An eating disorder is predominantly a symptom; not necessarily an illness in isolation. Choosing not to eat is often a way for someone to express their unhappiness with the world who can’t do it in other ways.”
The ten-bed inpatient unit is almost always at full occupancy.
“We care for around 75 patients each year, some have bulimia, some have a general anxiety disorder, but most have anorexia nervosa.” People aged in their late teens to early 20s make up the unit’s peak patient cohort.
“We also see a large female skew, but I don’t think that’s entirely because it’s a ‘women’s disease’. I suspect there are a lot of men with an eating disorder who might be too embarrassed to seek help, or the condition is disguised as something else.”
Patients aged under 18 are looked after by the highly skilled team at Flinders Medical Centre’s Paediatric Unit or at Child and Adolescent Mental Health Services.
“Of all the psychiatric illnesses, anorexia has the highest mortality rate, either through self-starvation or actively suiciding from depression. And because of the self-starvation factor, it’s important that we can get that eating sorted out before moving to cognitive treatment.”
While admission into the disorder unit is voluntary, patients must be prepared to undertake a two-to-three-week State-wide Eating Disorder Services (SEDS) program.
“We have a multi-disciplinary approach that includes consultant visits, a dietitian, psychology groups and occupational therapists looking at psychological aspects as well as the physical side of recovery. We also offer art and writing-based therapy activities to get them exercising their brains in ways they hadn’t thought of before.” Michael and his 16 nursing colleagues in the unit have one clear goal: “We get them to eat—it’s as simple as that and as difficult as that.”
And while starting a patient on the road to weight restoration is one part of the role, helping them to develop a healthy eating pattern is more important.
“Supervising during meals and snacks is actually a really pivotal part of our job. It’s therapeutic and enables us to sit down and really talk to our patients and build a rapport.”
“Patients eat together in the dining room with our supervision and, whenever possible outside of our allocated meal breaks, nursing staff try to eat with patients too.”
“It’s all about role-modelling, particularly from other patients who have been there a bit longer and are feeling better, so they can show newcomers, ‘I’ve been where you were and, look, I’m doing it now’.
“The look of fear of anxiety on a patient’s face when they’re confronted with a plate of food is quite staggering. I once had a person explain to me that their fear of eating outweighed their fear of dying.”
Michael says around a half of all first-time admissions are likely to be readmitted to the unit at a later date.
“People can leave at any time and they can return at any time. We’d never put a limit on how many times a person can come back to us. It’s really whatever it takes for them to get to a point where they don’t need us anymore.”
Michael knows of a number of patients who have come and gone from the unit for up to a decade.
“Some might say that ten years is an awfully long time for someone to come in and out of hospital, but I like to think perhaps because of the help we’ve offered, they’re still alive today.”
Flinders Medical Centre’s inpatient program works in tandem with the service delivery of SEDS outpatient services at Brighton, with the same consultants and psychologists working across both services. People with an eating disorder are up to 31 times more likely to take their own life. With successful treatment though, complete recovery is possible.
But, when it comes to beating the disease, it seems you can’t judge a book by its cover.
“Do we define success when someone has a healthy weight but is miserable? Or is it someone who’s underweight but happier within themselves?”
“As mental health nurses, if we can provide the support and encouragement to help our patients find their own inner sense of belonging and worth, then that’s a job well done.”