Lost in the system: lived experiences of eating disorder service models in Australia

BACKGROUND: In eating disorders, service models provide a structure for the delivery of assessment and treatment to people across a range of settings. High-quality service models can improve a person's satisfaction with the care provided, sustain them in treatment and promote better outcomes. OBJECTIVE: To capture and explore the perspectives of former service users, carers and eating disorder clinicians on their experiences of eating disorder service models. METHODS: This phenomenological study used semi-structured interviews to explore perspectives of former Australian service users (n = 5), carers (n = 15) and eating disorder clinicians (n = 29) on eating disorder service models. RESULTS: Thematic analysis identified four themes: (1) Navigating the service system, (2) Weight as a measure of progress, (3) Competent clinicians: a needle in a haystack and (4) Who is steering the ship? The first three themes were shared across all participant groups, while the fourth was specific to clinicians. Service models were described by participants as overstretched, contributing to shorter treatment duration, with skilled clinician shortages further constraining care. Participants reported over-reliance on weight to determine service model access (and thus, access to treatment) and as a trigger for discharge, despite consensus that recovery cannot be measured by weight alone. To enhance eating disorder service models, participants proposed strengthening the workforce, facilitating timely access, using more holistic outcome measures, and tailoring care to individual needs within coordinated, stepped service pathways. CONCLUSION: These findings highlight opportunities for system-level reform and the need for clearer leadership to guide consistent standards and accountability.