Exploring the treatment of eating disorders in rural Australian health settings: towards a model of effective rural service delivery

Eating disorders have the highest mortality rate of all psychiatric disorders (Arcelus, Mitchell, Wales, & Nielsen, 2011). In addition to the risk of death due to medical complications, approximately one out of five women with Anorexia Nervosa commit suicide (Arcelus et al., 2011). Considerable skill is required when working with this client population. Treatment needs are complex, and may contribute to staff fear and anxiety, resulting in a small number of clinicians feeling comfortable working in this field of practice, which may be more pronounced in rural settings. Rural service delivery as it exists at present is both inefficient and impracticable. Models of service delivery are inconsistent and as they have often been developed in metropolitan contexts, these do not always translate well into rural settings. There is also typically a small number of clinicians with an interest in ED treatment who in the absence of formal training, are required to engage in self-directed learning. However, there are some positive aspects. This research explores treatment issues and constraints within a rural setting, and relates to the existing literature in the area. The current study uses a qualitative methodology within the conceptual framework of hermeneutic phenomenology to explore the experience of clinicians working with eating disorders in a rural health setting in New South Wales. Participants engaged in semi-structured interviews to gauge their experiences of working with EDs in a rural setting, and to explore ideas around future service delivery. The analytic approach involves an iterative cycle of immersion in the data transcriptions and memos to identify themes. The qualitative software package NVivo 11 was utilised to assist with data organisation and thematic analysis. Whilst participants highlight various constraints working in a rural area, participants also illuminate some positive aspects of working within a rural setting that are explored in this research. Knowledge acquired from the interview participants themselves, in combination with a review of the literature, and an examination of The NSW Service Plan for People with Eating Disorders (2013-2018) is explored, in order to propose a more effective model of rural service delivery. Recommendations include the importance of ensuring the creation of collaborative Multidisciplinary teams assisted by improved methods of communication via the use of appropriate technology and the education of team members in the provision of concurrent models of care, from a holistic bio-psycho-social perspective. Key Words: eating disorders, rural service delivery, staff fear and anxiety, Hermeneutic Phenomenology