Suitability criteria

Why we have suitability criteria

Ngamai Wilam provides care for people of all genders, who are aged over the age of 18, and who have a primary diagnosis of an eating disorder in a voluntary residential/home like setting. The program aims to help participants work on various aspects of life that have been negatively impacted by their eating disorder this may include nutritional, psychological, emotional, interpersonal, social, cognitive, occupational or overall quality of life aspects.

The program incorporates safe movement as guided by the 'Safe Exercise at Every Stage [SEES]' guidelines; recognising that supporting a safe, sustainable and healthy relationship with movement can help participants achieve positive outcomes. We do ask however that movement trackers including Smart Watches and step counting apps are not brought into/used in the program.

The program is neither based in a mental health nor a general medical hospital. As such participants require a baseline level of medical and psychiatric stability to safely participate in and get the most benefit from the program. We understand that sometimes people have long-standing medical abnormalities. These can be discussed on a case-by-case basis and may be able to be accommodated with support from an appropriately qualified medical specialist. Similarly, dietary restrictions due to allergies, intolerances, sensory sensitivities, religious beliefs, cultural norms or ethical beliefs, can be discussed on a case-by-case basis during your intake assessment. At times we may require results from diagnostic testing and/or correspondence from consultation with a treating GP or physician.

Medical & psychiatric safety

While Ngamai Wilam is run by Alfred Health, it is based in a residential setting. This means that participants need to be medically well such that they could safely be managed in a community environment, such as at home. This environment cannot safely support somebody who is requiring naso-gastric feeds. Participants also require a baseline level of cardiac and musculoskeletal health in order to safety participate in the safe movement component of the program.

If somebody is feeling medically unwell, needing input from the emergency department or an inpatient medical hospital, feeling actively suicidal or engaging in self-harm, they are not able to participate in the program safely at this stage. People who are assessed as not able to participate in the program safely will be referred for further medical and psychiatric assessment and management as needed. Once these people are more stable, they are welcome to re-contact Ngamai Wilam about participating in the program.

Engagement with GP

Most of the time, while waiting for a bed at Ngamai Wilam, participants will need a GP in the community to monitor that they are medically stable and organise increased care if they become medically or psychiatrically unwell. We understand that this can be difficult for some people. We have partnered with Eating Disorders Victoria (EDV) to provide additional guidance and care while people are waiting for an admission. EDV can help guide people to link in with an eating disorder knowledgeable GP.

Ngamai Wilam can provide care for participants who:

Demographics

• Are over the age of 18
• The program is open to people of all genders
• Have a primary diagnosis of an eating disorder
• Require residential mental health care rather than community care or a day program
• Require sustained psychosocial recovery

Voluntary participation

• The program is a voluntary program. Participants must be willing to commit to the program. The program is a full-time and requires participants to be present 7-days a week for the full 4-12 weeks of the program. While participant’s goals for the program may differ, participants are expected to attend the group program, engage in prescribed meal plans for the 3 meals and 3 snacks times, engage in meal support, use oral supplementation when required, and be accepting of having regular medical monitoring including physical examination, weight checks and occasional blood and/or urinalysis as required
• The program is based around participants’ individual goals. Participants must be able to identify areas of their life that they would like to see improvements in and be open to, in a supported environment, trying to make change
• Participants must be able to consent to treatment. They must be classified as a voluntary patient under the Mental Health and Wellbeing Act

Medical suitability criteria

• BMI >14, with exceptions for individuals with enduring eating disorders - considered on a case-by-case basis
• Minimal risk of refeeding syndrome. Indicators of high risk of refeeding syndrome include:
  • Weight loss of 7.5% in 3 months OR > 10 % in 6 months
  • Evidence of severe muscle and/or fat wastage
  • None or negligible nutritional intake for > 7 days
  • Electrolyte abnormalities, particularly CMP (as described below)
• Able to meet one’s nutritional needs or build up towards meeting one’s nutritional needs without the use of nasogastric feeds.
• BP
  • >80mmHg systolic
  • Postural drop of <20mmHg systolic, <10mmHg diastolic
• HR
  • >40bpm and <100bpm resting
  • Postural rise of <20bpm
• Temp >35.5’ and <38’
• ECG – normal or changes are benign
• BGL >3mmol/L (random or fasting)
• Neutrophils >1.0 x 109/L
• Na > 135 mmol/L
• Mg > 0.7 mmol/L
• K > 3.5 mmol/L
• Ph >0.75 mmol/L
• Renal function eGFR > 60ml/min (Cockroft-Gault)
• ALT < 3 x upper limit of normal
• Alb >27 g/L
• Not requiring in hospital treatment for another serious medical condition

Psychiatric suitability criteria

• Able to manage distress without the use of alcohol, illicit substances, or self-harm
• No active suicidal planning or intent
• No active drug or alcohol dependence. The program is a drug and alcohol free space

If you are unsure whether Ngamai Wilam is the right service for you, we encourage you to reach out. We are happy to discuss your needs and explore the best options for your care.

Expressions of interest

If you or your healthcare clinician can provide the above eligibility documentation, please complete an expression of interest form.

Learn more

References

Safe Exercise at Every Stage Guideline

Abbreviations explained

• BGL – Blood glucose level
• BMI – Body mass index
• BP – Blood pressure
• bpm – beats per minute
• CMP – calcium, magnesium, phosphate
• ECG – electrocardiogram