Treating anorexia by nourishing the heart
Warren Ward's patients are often critically ill with diseases like anorexia.
Warren says asking someone with anorexia to eat is like asking an arachnophobe to put their hand in a jar full of spiders.
As a psychiatrist, Warren uses psychotherapy to help his patients.
He encourages those with an eating disorder to approach their mental illness as one part of their whole self.
His interest in the mystery of human nature informed his study of philosophy, and led him to examine the love lives of philosophers.
Further information
Originally broadcast in February 2022.
Lovers of Philosophy is published by Ockham Publishing.
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ABC News
3 hours ago
- ABC News
Calls for changes to mental health funding as Toowong Private Hospital announces closure after nearly 50 years
The financially strapped Toowong Private Hospital in Brisbane will close this week amid concerns seven other private mental health hospitals across the country are at "imminent" risk of collapse. Australian Private Hospitals Association chief executive Brett Heffernan blamed "rapacious profiteering" by health funds over three years as the over-arching reason for the 58-bed hospital's closure and the potential loss of more private psychiatric facilities. But Rachel David, Private Healthcare Australia's CEO, who represents health insurers, rejected the accusation. She's calling for a new model of funding for mental health care, saying psychiatrists were not admitting as many of their patients to hospitals. "Even if we were to double what we paid hospitals it still wouldn't stop the closure of more stand-alone mental health facilities," Dr David said. "There is a strong preference … only to treat the most severely unwell patients in hospital." For Toowong Private Hospital patients, such as Rebecca Kuenstner, who has been going to the facility in Brisbane's west for almost nine years, it has been a place of healing. "This has probably been the best thing that's ever happened to me," she said through tears. "It gave me a family pretty much. It's given me that sense of belonging really. "Especially when you live alone, it's quite difficult not having that support." Ms Kuenstner, 37, a former member of the Australian Defence Force who was medically discharged in 2014, has benefited from being an inpatient at Toowong Private Hospital, as well as completing courses there designed for people with post-traumatic stress disorder (PTSD). "I do come here quite regularly," she said. "You can come back and it's a very open space where you don't feel judged at all so you can go back and enjoy a cup of tea and chat to them. "That connection is probably the most important one after you're discharged so you're not left on your own. That was a very important part of my journey." She said she was barely able to leave home when she first started attending the hospital in 2016. The Toowong hospital, which treated 3,000 patients annually and would have celebrated half a century of operation in May next year, was expected to close on Wednesday. Its administrators said in a statement they were still investigating the reasons for its failure but "it is understood that the hospital was operating at a loss for several years". Mr Heffernan, who represents more than 600 private hospitals across Australia, said one major health fund had refused to renegotiate an annual contract with the hospital for 13 months. Another group had "simply refused point blank to contract with the hospital at all". The Toowong hospital closure comes as a cloud also hangs over 37 private hospitals run by Healthscope, which went into receivership late last month after its lenders withdrew support. However, Mr Heffernan said it was important to differentiate the Healthscope financial woes from the rest of the sector. "It's fair to say that Healthscope has had its own unique problems over a number of years in terms of its financial position and its financial management," he said. "What the rest of the sector is facing is a rampant health insurance industry." Mr Heffernan described Toowong Private's closure as "a massive loss to mental health". "We have a mental health crisis in this country and for an exemplar hospital to be forced out of business due to purely and simply the greed of the health insurers and the negligence of a federal government, that has known about this for two-and-a-half years but refused to act, is unfathomable," Mr Heffernan said. "Toowong is just the tip of the iceberg moving forward. We've been advised by eight of our members, in addition to Toowong, that they are in a similar situation facing imminent closure, seven of those are mental health facilities. Mr Heffernan did not want to name the hospitals publicly for fear of distressing patients and staff. He said the Toowong hospital had opened its books to Federal Health Minister Mark Butler more than two years ago to explain a shortfall in its funding. "Two months ago, the federal health minister laid down the gauntlet to the insurance industry saying you need to fix your house, you need to pay more of what you are taking to the actual providers of health care, being the hospitals," Mr Heffernan said. "We're two months down the track, nothing has changed. Our expectation at this point is that the federal government has no choice but to act, to intervene and to regulate the private health insurers to ensure that the traditional ratio of at least 88 cents in the dollar from premiums flows through to the actual providers of health care rather than just filling health insurers' coffers." In a statement, Mr Butler said he had called on insurers to "urgently increase the amount they pay out for hospital services and restore funding equilibrium across the sector". He said the federal government would continue to work on "long-term reforms to support the sustainability of the private health sector". "Ultimately, the solutions lie with insurers and hospitals working together," Mr Butler said. He has created a forum of private hospital and health fund CEOs with the Australian Medical Association and some patient groups to discuss potential solutions. "I've put a range of ideas that I want them to consider seriously about changes, particularly to mental health services," Mr Butler said. Dr David, who has represented health funds including big insurers such as Bupa, Medibank Private and NIB since 2016, would like to see them able to fund some of the costs of outpatient specialist appointments. She said some consumers were avoiding seeing a private psychiatrist in their consulting rooms because of fees of up to $988 for a first consultation. "We need a funding model that takes account of the fact that because of improvements in medication and techniques and medical understanding, a lot more mental health treatment is taking place in the community now than it did in the 1980s and 1990s," Dr David said. "I think that health funds do need the opportunity to be more flexible in how they fund mental health care, given we are in … a mental health crisis." While she's "still shocked" at the hospital's pending closure, Rebecca Kuenstner said she was yet to feel anger, adding with a laugh: "I've had a lot of therapy". "Moving forward, I haven't found where I'm going to be going to or where my support's going to be in the future … if I need help," she said.
ABC News
4 hours ago
- ABC News
Thousands of Australians are receiving ECT without consent every year
Rebecca* remembers fighting her clinical team all the way to the theatre, shouting the electroconvulsive therapy she was about to receive was against her will. "I felt completely helpless, that my body wasn't my own. I felt like I was in a movie," she said. "I was shocked they could actually administer it against my will." Health authorities describe electroconvulsive therapy (colloquially known as shock therapy or ECT) as a safe procedure, in which electrodes are placed on the head and seizures induced in the brain under general anaesthetic. Royal Australian and New Zealand College of Psychiatrists spokesman Dr Neil Coventry said ECT was one of the most effective treatments for severe depression and other serious mental illnesses, and modern ECT was delivered with precision and constantly monitored. "For people who are suffering and where nothing else has worked, ECT can quite literally save a life,' he said. Months on from her treatment, Rebecca is happier than before, and doesn't discount that ECT, as well medication or personal changes, may have benefited her. However, she describes the experience of having it forced upon her differently: "Invasive, old-fashioned, and frightening," she said. Rebecca was admitted to hospital voluntarily last year after experiencing periods of delusion, which included attempting to take a holiday without any identification or tickets. "I probably wasn't very well, but I'd never been like that before," she said. Shortly after admission, she was placed under a treatment order and told she would receive ECT. In the 2023/24 year, at least 1,700 mandatory ECT orders were approved in Australia, with courses usually lasting eight to 12 sessions. The true number was likely substantially higher, with some states not measuring or reporting approvals. In Victoria, a patient must lack capacity to give informed consent before they can be ordered to have ECT — a bar Rebecca said was never passed. "I have always been aware of what ECT is, and it is certainly something I would never have agreed to," she said. With the help of Victoria Legal Aid, she appealed the mandatory order, which the Victorian Civil and Administrative Tribunal (VCAT) overturned, ruling she had capacity and the ECT was scrapped. She had already received a number of ECT treatments, which she said left her foggy and with muscle pain. She also attributes ongoing memory loss that sometimes leaves her disorientated in the suburb where she's lived for a decade to the treatment. Her experience is illustrative of an issue reported by advocacy groups and contained in tribunal and court cases from around the country, which suggested rules surrounding mandatory ECT were often misunderstood or not adhered to. National Mental Health Consumer Alliance (NMHCA) chief executive Priscilla Brice said the number of people receiving ECT against their will was likely far higher than order numbers suggested, because data didn't identify recipients on guardianship orders. Feedback from NMHCA's partners across Australia identified "systemic risks" under many state and territory frameworks, Mx Brice said, including its use to enable coercive practices that violated human rights principles. Mx Brice called for the elimination of involuntary ECT. Each state had different rules, but most required a tribunal to approve clinicians' applications for involuntary ECT. Tribunals usually required a patient to be unable to give informed consent and be admitted to hospital involuntarily. Less restrictive treatments were usually required to have been tried first, and ECT had to be clinically appropriate. Tasmania was an outlier, with ECT not subject to any special regulation, although tribunal approval was still required. The state also didn't record data on orders the number of orders it was making. Although rules differ from state to state, insights from those tribunals tracking the data suggested the majority of applications for involuntary ECT were approved. Independent mental health advocate Simon Katterl, who worked at the Victorian Equal Opportunity and Human Rights Commission, said tribunals were often criticised for "rubber stamping" ECT orders. His criticisms are echoed by Victorian Mental Illness Awareness Council chief executive Vrinda Edan. "I only know of one or two cases where the tribunal has not agreed," she said. In the 2023/24 year, New South Wales Mental Health Review Tribunal (MHRT) approved 95 per cent of the 749 ECT orders considered. A MHRT spokesperson said decision-making panels included a lawyer, psychiatrist, and a third qualified member, and all decisions were made according to the law. "Often the patient has a legal representative who takes instruction from the patient," the spokesperson said. ECT order approval rates were similarly high in other states that monitor them. In Queensland, 92 per cent of applications for ordered or emergency ECT that made it to decision were approved. In Victoria, 87 per cent of applications were approved, as were all 18 in the Northern Territory. Dr Colleen Loo, a psychiatrist and former president of the International Society for ECT and Neurostimulation, said the high rate of approvals reflected clinicians' training and awareness of the rules, rather than rubber-stamping. Dr Loo said ECT was more beneficial for patients who lack capacity, pointing to a Singaporean study of 175 recipients with schizophrenia, depression and bipolar mania. It found those lacking capacity showed greater improvements in mood, functioning, and cognition, although patients were only monitored one to two days after treatment. Similar studies had not been conducted in Australia, Loo said, because research on those unable to consent would "be a nightmare to get any ethics committee to ever agree". Victoria Legal Aid fought more than 85 ECT orders in 2023/24 at the Mental Health Tribunal (MHT) and challenged other existing orders at VCAT, with some success, according to its associate director of mental health and disability law, Catherine Leslie. She said mental health issues and distress could be inappropriately used to argue a person lacked capacity, and clinicians at times confused least restrictive treatment with optimal treatment, focusing too much on what might be quickest. "Treating teams aren't necessarily getting it right," Ms Leslie said. The issues highlighted by advocacy groups like Ms Leslie's often formed the basis of legal challenges to mandatory ECT orders, and resulted in orders being overturned. Data from VCAT showed 19 of 24 challenges since April 2023 resulted in ECT being stopped. And in a recent Tasmanian case, a tribunal heard ECT treatment for a patient was cancelled just hours before she was due to undergo it, as clinicians realised she was not subject to a valid treatment order. 'It is clear from reviewing previous reported determinations of the Tribunal on reviews of assessment orders that there has been ongoing confusion and error arising in the use of the prescribed forms … over the last 12 months,' the TASCAT said in a decision published in December. '[This has resulted] in invalid orders being made and the detainment, assessment and treatment of patients, without legal authority.' TASCAT ordered a copy of the decision be issued to the Chief Civil Psychiatrist and Statewide Speciality Director to consider if further training was needed. A Tasmanian Department of Health spokesperson said an education and training program had been introduced, and forms revised to ensure risk of errors was minimised. "Revision of provisions around ECT will be included as part of the wider review," the spokesperson said. In another decision, this time at the Queensland Mental Health Court, a woman had 12 ECT treatments overturned after a judge determined less restrictive medication options had not been exhausted. Some advocacy groups believe Australia had to shift from a paternalistic approach, where clinicians ordered ECT because they felt it was in the patient's best interest, to an approach that prioritised human rights and self-determination. Queensland Advocacy for Inclusion (QAI) chief executive Matilda Alexander said Australia's approach should be brought in line with the World Health Organisation's (WHO) stance on ECT. The WHO and the United Nations issued a guidance and practice document in 2023 that stated: 'International human rights standards clarify that ECT without consent violates the right to physical and mental integrity and may constitute torture and ill-treatment". It also said ECT was "not recommended for children" and "this should be prohibited through legislation". Only Western Australia and the ACT have banned ECT for minors, prohibiting its use on children aged under 14 and 12 respectively. However, treatment of under 18s with ECT usually required tribunal approval. The guidance also addressed the fact there is "significant controversy' surrounding ECT, noting the treatment could result in memory loss and brain damage and its use 'dramatically declined' in countries around the world. There is some debate about the risks and benefits of ECT in the medical community but both supporters and opponents acknowledge that adverse event can occur. The Western Australian Chief Psychiatrist monitored for a range of adverse events during ECT, including premature consciousness, anaesthetic complications (including cardiac arrhythmia), muscle tears, vertebral column damage, severe headaches, and persistent memory deficit. It found that an adverse event occurred in nearly 13 per cent of ECT courses in 2023/24. The ABC approached health authorities in Victoria, Queensland, NSW and Tasmania with questions about each state's regulation of ECT. All defended their approach to involuntary ECT and the effectiveness of the treatment. A Victorian Government spokesperson said it had introduced legislation to reinforce an individual's rights in 2022 in response to a royal commission into the state's mental health system. Safer Care Victoria's Mental Health Improvement Program had also been set up to strengthen supported decision making. For Rebecca, that autonomy is key. "It felt unbelievable, getting my body back, getting my mind back." *Rebecca's name has been changed to protect her identity and ensure coherence to the Mental Health and Wellbeing Act
ABC News
a day ago
- ABC News
Drought pushes farmers' mental health to the brink across southern Australia
Farmers across southern Australia are counting the cost to their mental health as one of the worst droughts in living memory persists. With parts of South Australia, Victoria and New South Wales experiencing record-dry conditions over the past year or more, the battle to keep livestock alive and grow crops without decent rain has taken its toll on farmers and their families. Advocates say while some regions are finally starting to see some rain in winter, mental health in the farming community could take years to recover. Steph Schmidt is a psychologist who also farms at World's End in South Australia's Mid North. "It's been a really long, hard slog — at the moment, every area of agricultural South Australia is really struggling in one way or another," Ms Schmidt said. "We've got three young boys and a mixed sheep and cropping farm, and it's the daily decisions, or what are the decisions going to be in another couple of weeks' time if the rains don't come [that are difficult]. Ms Schmidt wanted farmers to feel comfortable acknowledging their struggles. "There is that stereotype that farmers and rural people are resilient, and we just get on with it, but helping people validate that it's OK when we're not OK [is important]," she said. "It is so hard at the moment, and if you're really struggling, then that's OK and understandable as well. Ms Schmidt has been travelling the state delivering mental health workshops for farmers and their families. "We've been full booked because everyone's just going, 'We need to be doing something,'" she said. "Often there's that realisation that, 'Oh, I'm not the only one experiencing this' … that validation of just how hard it is." As farmers sell off livestock because of a lack of feed or gamble with planting crops into dry soil in the hope of decent rain, mental health services are in increasing demand. Clinical psychologist Kate Gunn founded the online farmer mental health resource ifarmwell, which has doubled in use in the past year. "Farmers are increasingly realising that wellbeing is something worth investing time in and that it's something they aren't necessarily experts in addressing themselves," Dr Gunn said. "The impact of prolonged drought on farmers' mental health is quite severe. "The thing that creates the most stress is uncertainty." She said there were many resources out there for farmers, but also their families, who often felt the toll of tough times. "Sometimes it's really hard to know which ones to go to first, but I usually recommend … go to your GP, express the fact that you think you need some help, and usually they're the best ones to be across what's available in your local area," Dr Gunn said. Regional charity Rural Aid offers free mental health programs, including one-on-one professional counselling via on-farm visits and regular check-in calls. Chief executive John Warlters said it had experienced a 55 per cent rise in new mental health referrals in the past year. "We've seen a real upswing of calls and people reaching out … particularly in the last month — it's almost on a weekly basis there's half a dozen to a dozen people jumping on the phones, wanting [help]," Mr Warlters said. "It's symptomatic of them reaching a point where they've been really tested from a financial perspective, tested emotionally, and they've cleverly or wisely recognised, 'Maybe I do need a bit of help and support.' "I'm pleased people are reaching out — I'm just very concerned given the circumstances of what's prompted them to reach out and this ongoing drought." Andrew Shepherd's farm is located in a usually reliable rainfall area in SA's South East, but he has been confronted by dry paddocks at the start of winter. "I think if we'd tried to tell our kids 10 years ago that we'd be where we are now, no-one would believe us," Mr Shepherd said. "We've been through dry periods before, but not for this long and not to this extent." Last year, Mr Shepherd and some mates set up a Naracoorte chapter of Fat Farmers — a tongue-in-cheek name for an exercise group set up by farmers to encourage physical exercise for its mental health benefits. Fat Farmers now has numerous groups across SA and is working to expand nationally. "Anyone that's doing any running or any sort of sport … you feel better," Mr Shepherd said. "Doing it in a group of people, we're talking, we're out there, we're getting off the farm, we're getting away from the stress, especially of what's happening out here at the moment." He encouraged other farmers to take what time they could to look after their mental health, and not feel as though they had to do it alone. When drought-breaking rain finally arrives, Dr Gunn warns it will not wash away the lingering impacts of years of drought. "It doesn't wash all the worries away, unfortunately," she said. "Farmers will still have debt that they have to service, it'll take a long time to rebuild stock, it'll take a long time for crops to grow, for that grain to end up in the silo and them to be paid. "If it rains, that'll be great and it will certainly give people hope, but it doesn't translate immediately to zero mental health problems."
