EVIDENCE-BASED PRACTICE

 

 

 

RED HOUSE is designed to be a unique service. It is not a copy or adaptation of any other specific service or program from anywhere in the world. It does however, comprise a number of aspects drawn from a variety of different positive approaches – some relating specifically to the treatment of eating disorders; some relating to treatment of general mental health issues; and others relating to general human health.
 

Some may question the ethics in providing a treatment framework that has not been “tried and tested” somewhere else in the world. However, I question the ethics in continuing to provide treatments which we know yield incredibly poor long-term outcomes. When I have explained the concept of RED HOUSE to various people over the past decade, I have commonly been met with questions along the lines of: “what evidence-based model or program are you replicating?” and “where in the world does it come from?” I have no reservations in admitting that the overall framework of RED HOUSE cannot be deemed “evidence-based” in the common usage of the term, since it has never been tried and tested anywhere in the world. If I were to copy some other program – either local or from anywhere else in the world, I would only generate the same long-standing dismal outcomes, and to me that would be a complete waste of time and completely defeat the purpose of my efforts. While current practices continue to deem themselves “evidence-based”, the truth is that it is only adding to the plethora of worldwide evidence proving the complete inadequacy and inefficacy of those practices. They continue because people are scared to step outside of the orthodox frameworks, for fear of scepticism and criticism. To me, the risk of not stepping outside of past and current framework is far greater than the risk of trialling innovative approaches. No advancement in science and medicine can be made without some level of risk, and without some deviation from orthodox methods. RED HOUSE is taking a very well-informed, educated and calculated step - one that I believe will have enormous pay offs. Improved outcomes can only be derived from innovation and the creation of new evidence, and that is the intention of RED HOUSE. I hope that any successes we achieve will spawn new scientific investigations, which can provide a peer-reviewed evidence base of practices that are efficacious.

While not duplicating a model or framework that has been “tried and tested” anywhere else in the world, RED HOUSE has been developed utilizing the 5 core principles required for quality, sustainable Public Health service provision. These core principles are: effectiveness, efficiency, equity, quality and accessibility. They are principles which are severely lacking in hospital-based services for eating disorders. They are principles which are reflected in our philosophy. Further, the sum of its parts – i.e. the individual services and models comprising RED HOUSE – all carry significant supportive evidence in terms of their application to general human physical and mental health. By combining the individual components and practices into one framework and applying them to eating disorders, RED HOUSE is providing innovation and advancement in treatment. The so-called “evidence based practice” that has been, and continues to be applied for the past 30 years, has only rendered woeful, and all too often tragic, outcomes. And I use the term tragic not only in reference to the high death rate, but also pertaining to the extremely poor quality of life suffered by so many severe and chronic sufferers of anorexia and other eating disorders.

“He has a right to criticize, who has a heart to help.”  (Abraham Lincoln)

 

While I do not doubt the good intentions of individual psychiatrists and other medical and allied health professionals, and I know there are some individual practitioners who bravely defy the mainstream, I feel psychiatry and the medical field in general have a lot to answer for when it comes to past, and continued attitudes toward, and treatment practices for anorexia. How such antiquated methods, which have only led to an increase in deaths and disheartening long-term recovery rates, can be deemed logical, ethical, and acceptable is just beyond my forbearance.

There are some sobering statistics in relation to eating disorders in Australia. For example:

 

  • Almost one million people (approximately 90% of which are women) in Australia struggle with a diagnosed eating disorder, and incidence rates are rising.

 

  • A further 20% of females in Australia are thought to have an undiagnosed eating disorder, and approximately 15% of all women experience an eating disorder at some point during their life.

 

  • Anorexia has the highest mortality of all mental illness;

 

  • Mortality rates have risen from approximately 10% to approximately 20% over the past 25 years. 1 in every 5 deaths is by suicide;

 

  • Research indicates that only 46% of patients fully recover from anorexia, and most of these cases have received early intervention. At least 20% remain chronically ill for life, and around 20% die between the age brackets of 15-25 and 35-45.

 

A report by Deloitte Access Economics (2012), prepared for the Butterfly Foundation, revealed that the total socio-economic cost of eating disorders in 2012 was $69.7 billion (p. 9). People with chronic eating disorders typically require regular, lengthy and costly hospital stays, for the most chronic cases, intermittently for a lifetime. Due to the inadequacy of medical and psychiatric hospital wards in meeting the diverse and very individual needs of chronic patients, they are an extremely ineffective form of treatment. Moreover, treating these patients in an environment that knowingly results in poor outcomes is a gross waste of resources (time, money, staff energy, and bed occupancy). The problem lies in having no other option available. Thus, these wasted resources need to be redirected into creating a new, more effective and efficient option, particularly for this sub-group of chronic cases. RED HOUSE will achieve this.

 

Despite accounting for 43,203 psychiatric care hospital days in 2006-07 (AIHW, 2009), less than half of all eating disorder patients achieve enduring positive health outcomes. Managing these cases in a community residential setting, which has been specifically designed to meet their individual needs, would not only be more appropriate and provide better outcomes for the patients; but also substantially more cost-effective; and it would free up a significant number of long-stay hospital beds. Identification of these specifics is the very foundation on which the RED HOUSE program has been built.

 

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Mental Health and Eating Disorder Services in Australia

 

 

©  Website created by Mary Jane Lawson. Updated 2019.