A new eating disorder credential – Gaining the right skills to deal with complex issues

Eating disorders are highly complex and often chronic psychological illnesses that substantially impair physical health and disrupt psychosocial functioning. Individuals with eating disorders experience high levels of psychological distress, long-term medical complications and are at greater risk for premature death and death by suicide (Hay et al., 2015). Consequently, eating disorders have disproportionately high morbidity and mortality rates and carry significant disease burden. On account of their severity, it is not surprising that eating disorders have been shown to have one of the greatest impacts on health-related quality of life of all psychiatric disorders (InsideOut Institute, 2021).   

Over the past decade, there has been an increase in eating disorder presentations within Australia. It is estimated that one million, or four per cent of the Australian population, are living with an eating disorder in any given year (Deloitte, 2012). The COVID-19 pandemic saw a dramatic rise in the number of Australians presenting with distress associated with disordered eating (McLean, 2021). In this period, people with an eating disorder reported an exacerbation of illness symptomology and members of the general public reported increased instances of binge eating and food restriction (Phillipou et al., 2020). Moreover, one study that examined the effects of the pandemic on people with a lived experience of an eating disorder, indicated that almost half of the young adults whose eating disorder symptoms were previously in remission, reported their re-emergence during the pandemic (Miskovic-Wheatley et al., 2022).  

In response to the increasing prevalence of eating disorders, the Australian Government Department of Health and Aged Care (DHAC) has implemented significant policy changes and allocated $111 million to improving patient access to Medicare and inpatient treatment facilities. Under the Medicare Benefit Schedule (MBS), individuals with a clinical diagnosis of anorexia nervosa, bulimia nervosa, binge-eating disorder, or other specified feeding or eating disorder are now eligible to access up to 40 psychological treatment sessions and 20 dietetic sessions in a 12-month period through an Eating Disorder Management Plan. In addition, DHAC has allocated funding for research through the Million Minds initiative and the National Eating Disorders Research & Translation Centre, as well as the Eating Disorder Residential Program initiative which will see the establishment of six residential centres around Australia.   

In addition, with the support of DHAC and by recommendation of the MBS Eating Disorders Taskforce, the Australia & New Zealand Academy for Eating Disorders (ANZAED) and the National Eating Disorder Collaboration (NEDC) have developed a credentialing system to formally recognise the skills and training of clinicians experienced in the treatment of eating disorders. The system aims to build a more effective and competent workforce and facilitate interdisciplinary communication in eating disorder treatment, ensuring all Australians who are at risk of or experiencing an eating disorder have access to a safe and accessible system of care.

What is the credential?  

The ANZAED Eating Disorder Credential provides formal recognition of the qualifications, knowledge, training and professional development activities required to meet the minimum standards for delivery of safe and effective treatment. In doing so, the credential endorses transparent minimum standards for eating disorder treatment based on the NEDC Core Competencies (NEDC, 2018) and the ANZAED Clinical Practice and Training standards (Heruc et al. 2020a, Heruc et al. 2020b, Hurst et al. 2020), and recognises the significant investment by health professionals – in relation to their training and professional activities – to meet these standards. The credentialing system aims to build the eating disorder workforce by promoting these standards and encouraging continuing engagement in professional development across eligible professions.

The credential is designed to recognise clinicians providing treatment for individuals with eating disorders across all diagnostic presentations, from early intervention through to long-term care, both in public and private settings. The credentialing system is open to – but not compulsory for – professionals in mental health, such as psychologists, social workers, occupational therapists, mental health nurses, counsellors, general practitioners, nurse practitioners, psychiatrists and psychotherapists, as well as dietetians who meet the criteria for the credential. 

In addition to building a strong workforce of clinicians, another aim of the credential is to ease pathways to care, allowing individuals with eating disorders to access high-quality, evidence-based interventions in a timely manner. Despite there being an extensive range of treatments available for individuals with eating disorders, evidence indicates there is a large and widespread treatment gap, with only a small proportion of individuals who meet the criteria for an eating disorder receiving a formal diagnosis and the appropriate treatment.

A systematic review reported that the proportion of individuals seeking treatment for an eating disorder was only 23.2 per cent, with most people seeking care more than a decade after the initial onset of symptoms (Hart et al., 2011). Alarmingly, when individuals with an eating disorder do receive care, they are rarely treated with evidence-based interventions (Kazdin et al., 2017). The credential aims to overcome this gap by creating consistency and standards across treatment provision for people experiencing eating disorders.

People experiencing an eating disorder, as well as their families and supports, frequently report that finding a treatment provider with the appropriate knowledge and understanding of their condition is difficult and existing pathways to care are challenging to navigate and lack uniformity (Johns et al., 2019). In Australia, there is a shortage of services provided by outpatient and specialised eating disorder community clinics, and most children and adolescent patients are discharged from hospital without any follow-up.

Moreover, clinical practice guidelines for DSM-V eating disorders suggest a multidisciplinary approach to treatment optimises therapeutic outcomes (Hay et al., 2014). However, due to clinician backlog and extended waiting times, it is often not feasible to coordinate a diverse team of competent and experienced professionals. This places greater stress on primary care physicians, as well as people with an eating disorder and their families (Tse et al., 2022).   

What is my role as a psychologist?  

Psychologists are integral to the mental health workforce and play a vital role in the diagnosis, treatment and management of eating disorders. With the increasing prevalence of eating disorders in Australia, it is very likely that psychologists will encounter someone experiencing an eating disorder within their clinical practice. Unfortunately, recent research has shown that many clinicians express reluctance to provide treatment for people experiencing an eating disorder (Cain et al., 2017). Encouragingly, adequate training and supervision in eating disorders treatment for trainees and supervisees has been shown to promote willingness to treat, provide support in challenging situations and assist in managing negative emotions (Bamford & Mountford, 2010; Satir et al., 2009).

The credential criteria have been designed to ensure a minimum standard of evidence-based care. Building on existing qualifications, clinical knowledge and skill, the additional eating disorder-specific introductory and treatment-provision training will support clinicians to provide safe, effective treatment. This entails 12–17 active training hours.

The further requirement of ongoing professional development relevant to eating disorders aims to enhance and strengthen clinical skills and knowledge, enabling clinicians to support someone experiencing an eating disorder to fit within core practice for psychologists without requiring a completely different skill set than that which is developed through providing treatment for other diagnostic presentations. In building capability within the existing mental health workforce, capacity for early recognition and intervention in eating disorders will be enhanced, with consequent improvement in treatment outcomes (Bryant et al., 2022).  

Where can I find out more?  

If you are interested in learning more about becoming a Credentialed Eating Disorder Clinician, visit the connect·ed website.

If you need to refer a client for eating disorder treatment, you can find a Credentialed Eating Disorder Clinician using the Find a Treatment Provider directory. This is a searchable database designed for people with an eating disorder, their supports and referrers to quickly and confidently find and connect with Credentialed Eating Disorder Clinicians. Clinician profiles on connect·ed can help a person to make informed decisions regarding the professional they wish to engage with. People seeking treatment will also be able to identify Credentialed Eating Disorder Clinicians by their verified visual digital badge and the postnominal ‘CEDC’. By accessing a list of clinicians who meet the minimum standard for the provision of safe and effective eating disorder treatment, accessibility and quality of treatment will be enhanced and interdisciplinary lines of communication will be improved.

What is happening now?

The initial response from psychologists across Australia has been overwhelmingly positive. Since the launch of the credential, more than 1300 clinicians, primarily psychologists and dietitians, have applied. The Credential Professional Development Packages rolled out by NEDC have also led to increased opportunities nationwide for professional development and supervision. This initiative has supported nearly 350 psychologists to access the training and supervision required to meet the criteria.

We are delighted that the Find a Treatment Provider directory is live and available for all eating disorder stakeholders, with the connect·ed website receiving more than 60,000 pageviews and almost 8000 new users since the end of June. We look forward to seeing the impact of the credential and the directory, not only on the treatment of people with eating disorders but also on the capacity and competence of the national eating disorder workforce.

Contact the authors

Further training and resources

https://psychology.org.au/training-events/events-calendar?s=eating-disorder-series