Dr Carly Roukos on life at Wandi Nerida residential treatment centre

Dr Carly Roukos 00:12
We offer a lot of extra more creative, expressive therapies and a lot of it is surrounded with connecting with nature connecting with animals. So we have Equine Assisted Therapy that runs every week we have four horses that the participants really loves them and they not only do therapy with them, but also take part in looking after them. So feeding them, grooming them that sort of thing.

Sam Ikin 00:35
Inpatient care has proven to be a vital tool in our national efforts to reduce the burden of eating disorders. Australia’s first eating disorder specific residential care centre on Queensland’s Sunshine Coast is called Wandi Nerida and it’s been successfully operating since 2021. It’s owned and operated by Butterfly Foundation. A study by Monash University recently found that Wandi’s inpatient care resulted in significant improvements in quality of life and reduced healthcare costs compared to life beforehand. In this episode, we’re going to do a deep dive into what that experience is like at this amazing facility with the help of one day’s clinical lead, Dr. Carly Roukos.

Dr Carly Roukos 01:17
I’m from the United States. As you can probably tell.

Sam Ikin 01:20
Oh really didn’t notice.

Dr Carly Roukos 01:21
Everyone’s all like, you are the most American sounding person we’ve heard. When did you arrive in Australia? But I’ve been in Australia for seven years. And yeah, so I’ve worked in the US. When I was getting my degree in psychology, I was really interested in eating disorders and helping people with eating disorders. So I worked in outpatient settings, inpatient settings day programme setting, and that I had always wanted to kind of my dream job was to work in a residential facility. But when I moved to when I first moved to Australia that didn’t exist here. So I kind of thought, well, I guess this just may not be something that I get to do. And that’s okay. And I’m sure I’ll find other ways to work with people with eating disorders. And then one generic popped up around, I think I heard about it in 2020. And I was like, Oh, my gosh, this is like, literally exactly what I want to be doing. And it’s the first one and it’s in Australia. And that’s so exciting. So wow, yeah, I was living in Western Australia at the time, but I applied for the job to come over and work as a therapist, and I’ve been here ever since we opened. So it’s been like, a really special opportunity for me.

Sam Ikin 02:24
I love it when things just work out like that, too. I mean, you know, the people who really want those jobs tend to be the best ones to get them as well. So that sounds like it is a very serendipitous kind of a meeting of minds. In my experience, you know, I have a long history with eating disorders. And before we even knew about eating disorder, residential care, I, at one point just went like this is so out of control. I don’t know what to do. And I booked myself into rehab. And it was a clinic that was based on the meadows from the US and it was almost exactly like 28 days that movie with Sandra Bullock.

Dr Carly Roukos 03:04
Yeah, I haven’t seen it. But I feel like I could imagine what it’s like.

Sam Ikin 03:08
And yeah, even the holding hands and singing stand by me at the end as to what what sort of support? Do you get at Wonder Nerida? Or their horses? Do you have bushwalks? And things like that? Other than and then I guess, is there a lot of group therapy? Or? What’s it like in that? Yeah.

Dr Carly Roukos 03:24
So I would say? That’s a great question. Primarily, we do run, it’s a group therapy based programme. So we offer lots of group therapies. Some of them are more skills based. And some of them are the more processed based groups, which is maybe what you see in the movies a little bit more where people are kind of talking to each other about what they’re going through connecting over certain things. Maybe like a bit like what you might imagine in an AAA meeting, although it isn’t actually like that, but it might be what somebody could imagine that is like, but then on top of that we offer like an individualised team for every participant that comes through. So you have a dietitian and a therapist that work with you throughout the duration of your say, they meet with you a couple of times each week, and they help you kind of move through the programme and really tailor the treatment to your needs. And then above and beyond that more kind of traditional therapy stuff. We offer a lot of extra more creative, expressive therapies, and a lot of it is surrounded with is sort of based in connecting with nature connecting with animals. So we have Equine Assisted Therapy that runs every week. We have four horses that yeah, that’s yeah, it’s good. Yeah, we have four horses here. And yeah, the participants really loves them. And they not only do therapy with them, but also take part in looking after them. So feeding them, grooming them, that sort of thing. What’s

Sam Ikin 04:45
the theory behind that? What Why Why is that so important? Yeah,

Dr Carly Roukos 04:48
so a couple of reasons. Definitely. This is sit therapy. It’s kind of a new and emerging therapy that I think is becoming a bit more widespread now. But essentially the focus of it is on Our somatic or I guess another way that I was like our emotional experiences and learning to understand what emotions were feeling and how to regulate those. So it turns out that horses are actually very, very perceptive and responsive to human emotions. So they are really, really sensitive and can pick up kind of what we’re feeling and we’ll respond to is based on what emotion we might be feeling so that they actually can help us to learn what we might be experiencing ourselves based on kind of how they’re reacting. So it’s a very interesting thing, obviously, they can’t talk. But it’s this very interesting thing that happens, where we, we learn about them, and we learn to pick up on what signs their body language is giving. And then that, in turn, helps us to reflect on what we might be experiencing. And traditionally, people with eating disorders do tend to have a hard time connecting with and feeling their emotions, eating disorders are often about avoiding or numbing out difficulty motion. So part of that healing process is learning to be able to identify and then sit with and tolerate what we’re feeling. Yeah,

Sam Ikin 06:01
sorry, I totally got sidetracked. That was that was the more that you wanted to tell us about? The support?

Dr Carly Roukos 06:08
Oh, yeah, just so we also offer things like nature based therapy, we offer drama and art therapy, we do a nature walk once a week for those that are safe to engage in that. So really trying to connect with nature and have have experiences that that feel good, right? We know that being out in nature can be really healing for people. So we don’t just do the traditional talk therapy sitting in a room,

Sam Ikin 06:35
it sounds like it is an amazing place to go and that the care that you get is going to be unlike anything else that you’ve ever had before. What’s the setting like up there on the Sunshine Coast? It sounds like it would be very pretty.

Dr Carly Roukos 06:49
Yeah. So we’re located in the Missoula Valley, which is about 25 minutes inland from the coast, about an hour and a half north of Brisbane. So we’re on a lot of acres, I don’t know how many, but it’s a lot. And we have, we have a horse arena, they have different paddocks that they’re in, we have a big beautiful garden that our participants will plant things in and harvest things from. We have both indoor and outdoor spaces to have therapeutic groups. And so when the weather is nice, which it usually is, except when it’s pouring down rain, we’ll have a lot of our groups out on the veranda. And yeah, as I was mentioning that nature walk, we do that all on our grounds. So it’s very beautiful. And we try to utilise that outdoor space as much as we can, because it’s really peaceful. It’s really calming. And I guess we’re trying to step away from that kind of more clinical hospital feel, or everything’s super sterile and indoors, we do have an indoor residents as well, obviously, everybody has a room. And we do run some groups in there. But even that we’ve really gone through a lot of effort to make it very home, like just the way that it’s decorated, the couches, we try to have it feel as much not like a hospital as possible and as much like a home as we can. So we have a kitchen that our participants will kind of cook in similar to kind of what you would be doing at home, we eat together family style around big tables. So really trying to make it as kind of comfortable as possible. And not even just comfortable but realistic, I guess as to what people’s home environments are like. Because the reality is that transition from treatment to home can be really difficult. So as much as you can start to practice those real life things in a real life setting that’s going to help with that transition back home.

Sam Ikin 08:34
We were saying before, it is closely connected to Monte Nido and Carolyn Causton, one of our first guests on the podcast, who is like I think anybody who’s worked in the eating sort of space anywhere in the world knows who she is, and and tell us about the model of care. And how has it been shaped since the inception? I guess?

Dr Carly Roukos 08:54
Yes. So we work closely with Carolyn, she’s been involved since before we opened and has ongoing gives us ongoing support. She does visits twice a year and closely works with our team. Our model of care is based off of this concept that she developed that we’re all born with a core healthy self. Nobody is born with an eating disorder. But basically what happens is that throughout the course of our lives, an eating disorder self may develop in order to help us deal with a certain problem or protect us from something or deal with difficult emotions or traumatic experience as. And so the model of care is really based off of understanding that eating disorder part of us and even like dialoguing and talking to that part of us understanding the function that it’s serving, and then learning how to get those needs met from our healthy self. So it’s not actually about getting rid of our eating disorder in terms of that part of us. It’s just about integrating the healthy self with the eating disorder itself. And learning the eating disorder self actually develops to protect us and to keep us safe and that can be white, so scary to let it go. So we want to honour that and acknowledge that but then also learn to respond to these difficult things that happen in life without sort of taking it out on our bodies or our self. But learning how to kind of really respond from a healthy place. If you’re

Sam Ikin 10:12
just robbing things in such a graphic kind of a way that makes sense on such a different level, the fact that there is. So I’ve always, and lots of people we’ve spoken to have said that, you know, the eating disorder is never not going to be part of you. It’s going to be, you know, maybe you can overcome it, but it is a part of you that has a purpose. And I think the way you described it just then there was you born without it, and it’s kind of serving a purpose.

Dr Carly Roukos 10:36
Yeah, I will say it doesn’t last forever, though. Like, I just want to make sure because it’s not the idea that you’ll have the eating disorder forever. But I guess the eating disorder self, it’s almost like a bit of an alarm system where when that part gets triggered, it’s actually telling you, hey, I met not feeling safe right now, or I’m not feeling okay. And so we learn to respond from our healthy self. So I guess I just want to make that distinction. It’s not that I think, yeah, that I think you can’t recover from an eating disorder fully recover, because people do fully recover and have fully recovered. But it’s that we’re not getting rid of the part of ourselves that has developed to protect ourselves because we, we want that part of ourselves. Right, if that makes sense.

Sam Ikin 11:18
Totally. And I certainly wasn’t suggesting that, that you could never recover. But so from where I’m sitting, I’m in a reasonably good place and have been for a while, but I’m always, it’s always the back of my head is, you know, is this behaviour here? Is that going to trigger, you know, a path down? You know, somewhere that I don’t want to be and, yeah, I guess that was the feeling I was getting to, but no, we say that recovery is possible all the time on this podcast. And I think, very happy that you made that that distinction. It’s important. So who can who can come who can attend? Yes,

Dr Carly Roukos 11:53
so we can take anybody that’s 16 and above. So that’s inclusive of any gender, you just have to have, I guess it diagnosed eating disorder. So anorexia, bulimia, binge eating disorder, are spared, so even sort of not otherwise specified in the old DSM criteria, and 16 and above. So anybody is welcome to apply. And that includes people from overseas, we’ve had some overseas participants come through, but the majority of our participants are currently from Australia.

Sam Ikin 12:30
Right. And I certainly we like to, to point out that the stereotype is quite unhelpful when we’re talking about eating disorders. Although all of those diagnoses that you see, do you tend to prioritise people whose health may well be in imminent danger or, you know, close, you know, people who really need the help, and I guess that sort of, sometimes the lends itself more to anorexia nervosa and perhaps bulimia nervosa?

Dr Carly Roukos 12:59
Yeah, so I guess, to require, we don’t look at it in the way of we would only take people whose health is compromised, because eating disorders are primarily a psychological illness. And yes, they can have medical consequences. But I would never say this person is more sick because their jobs look worse, or their pathology looks worse. It’s more about the behaviours, that person the behaviours and the thoughts that person is struggling. And that’s how we sort of do our assessments. That being said, though, that the type typically the referrals we tend to get, we do get more referrals for anorexia nervosa, I would say. But that’s not to say we would prioritise someone with anorexia over somebody with bulimia or binge eating disorder. It’s really about how is this eating disorder impacting the individual? And do they require this level of support to get better, and actually, the medical stuff we do, of course, look at that, and we monitor it, but that doesn’t actually give you a lot of information about how severe someone’s eating disorder is. Because you can be, quote, unquote, healthy in the sense that your observations of pathology and your weight might look to be in the what quote, unquote, normal range is, but that doesn’t actually give us any information about how much someone is struggling psychologically. And I think we really want to step away from that stigma or that idea that you have to be physically really unwell in order to deserve care.

Sam Ikin 14:21
I love everything that you’re saying. It’s it’s very refreshing to hear a person centred rather than a strictly medical observation kind of approach. And I guess that’s where the difference between in hospital and what you guys do is, I guess, am I on the right path? Is it so? I guess what, what makes Monday different to hospital care? Yeah,

Dr Carly Roukos 14:46
so I guess we have the luxury of stepping away a little bit from those really ingrained medical systems that we have and there’s a place for hospital there’s nothing wrong with hospital and sometimes people really need that often. People will come through hospital first and then come to us. Because we do have some minimum criteria and that you have to be somewhat, you have to be stable enough that it’s going to be safe for you to be here. So, but yeah, I think some of the differences are that it’s quite individualised. We’re not going to ever discharge someone or say that they don’t need care based on them meeting a certain psi or wage or even medical stability, we’re really looking at that bigger picture in terms of the psychological well being as well as the medical well being, I think hospitals often don’t always have the luxury or the resources to be able to do that. So we’re really lucky that way that we’re able to continue to support people, not just until they’ve reached medical stability, but beyond that.

Sam Ikin 15:45
It sounds like it’s quite intense. The the treatment, how long is somebody typically in?

Dr Carly Roukos 15:51
Yes, so typically, people are here between 60 and 90 days, so about two to three months. Yeah, so we ask when we first do an intake with someone, we ask them to commit to a minimum of the 60 days, which is quite a big commitment. And then a couple of weeks before that’s up, we have a discussion about whether or not they would benefit from some extra time, depending on the goals that like the progress they’ve made, and what they still want to get out of it. And then we make a decision from there. If this rate, the extra months would be helpful.

Sam Ikin 16:21
The whole idea of a dietitian, for me was quite triggering for a long time, you know, they’d bring out a little plate the lines on it, and that to me would just be like them telling you to restrict and of course, for someone who is experiencing an eating disorder or disordered eating, that’s, you know, that that’s problematic. How does it how does it all work

Dr Carly Roukos 16:42
of what you described about that kind of more traditional, maybe what we think of when we think of a dietitian, somebody telling us you need to cut this out and lose weight, and you know, all that stuff that is not at all the way that our dieticians operate. So they’re all really aligned with Hayes Health at Every Size. And there would never be putting anybody on any sort of restriction restrictive or weight loss based programme. So they’re really what they’re doing is helping to understand, you know, what has a client been struggling with in terms of their intake and what they’re eating? And how can they support them to have a more flexible and healthy relationship with food? So we follow the raves approach. Are you familiar with rave?

Sam Ikin 17:23
Why I am, but please, tell me Yeah, so

Dr Carly Roukos 17:25
raves is about kind of following some things of how do we start to normalise our eating. So the stands for regular eating, which is three meals and three snacks, adequate eating, so making sure that we’re having an asset, those meals and snacks, variety, so including a variety of different foods, eating socially, so being able to eat with other people. And we do this, for example, as we eat together, all of the meals in the dining room. And then we also do social outings. So a breakfast outing and a dinner, adequate participants can practice going out to restaurants and things and eating in that way that we would in regular life. And then the final final one is spontaneity. So that kind of moving more towards, you know, maybe you’ve already had your snack, but your coworker brings in cake for a birthday and being able to have that flexibility to have a piece of cake. And so our participants, they might practice that in the later stages of their stay right where they might sometimes we go up to the fire pit and roast marshmallows, and maybe it’s not on their meal plan, but they feel like having a marshmallow. So they have a marshmallow because that happens in real life. So following along with that, I’m sure a dietitian could probably go more into detail around that. But that’s sort of the approach that we’re taking. And then in terms of at the table, all of our staff do support what we call supportive meal therapy. So that’s the dietitians. That’s the therapist, it’s the nurses, it’s the recovery navigators, which are like our peer workers. And what we do is we all eat together, we eat the same things, we engage in kind of normal conversations around the dinner table that you might talk about with your friends or family. And we’re really just there to kind of role model what it’s like to have that more flexible and healthy relationship with.

Sam Ikin 19:04
And so beyond the psychology and the dietetics what other types of therapy do people experience while they’re in while they keep saying while the Rain likely gonna, like, you know, while this day, so,

Dr Carly Roukos 19:17
like we talked about before, we have equine therapy, nature based therapy, art therapy, drama therapy, we have nutrition group, we have our core process based groups, which are the more process based therapeutic groups, some more skills based psychology group. We do some peer support groups, those are led by our recovery navigators, which was like a peer work for us and many of them have lived experience of an eating disorder themselves. So that might be engaging in discussion and conversation around that and how sort of they have gotten through those experiences. And then we also do just like some fun, like on Sundays we do an outing where we just go to the beach or To the markets or just to kind of get out and about a lot of times people with eating disorders have become quite isolated and maybe has sort of lost a lot of connection with those more fun parts of life. So we try to reengage with that as well.

Sam Ikin 20:17
Wow, the look this, the differences between hospital care and you know, what you guys offer is a starting point. There’s there’s nothing, even close to the similar. Why is this one? Why is it more successful than what traditionally has been on? Well, what what’s traditionally been available?

Dr Carly Roukos 20:35
Yeah, I guess the gaps that we’re trying to sell. And I think why it is helpful is that traditionally, people have gone, maybe to enter hospital for like a refeeding programme, and then gone out without a lot of the skills that you actually need to maintain recovery in the community. So things like grocery shopping, portioning, their food, cooking their own meals, that socially eating, I was talking about eating out at restaurants, a lot of that stuff, it’s hard to do that in hospital. So yes, you might be able to get a bit more nutrition in hospital, but then you maybe haven’t had much of an opportunity to build up those skills of how to transfer that back to your regular life. So I guess what we’re trying to really do is to give people lots of practice in that area, so that when they do transition home, they feel like they have some, they’re, they’re empowered, and they feel like they have some skills built up. So it doesn’t mean when they leave here, there, they don’t need any more support, of course, people are going to it’s a long journey, and people are going to still need, you know, to touch base with therapists and dietitians or maybe do a day programme. But I guess we’re trying to fill that gap from Super intensive clinical refeeding, to living on your own at home. And maybe not knowing how to cook yourself an adequate meal, or how to eat regularly throughout the day to avoid bingeing later on or how to not know engage in other behaviours that have maybe become quite familiar to

Sam Ikin 21:54
the colleague that you would just had, who’s helping us get past the technical issues we have, before we did the interview seemed lovely. It seems like a very close knit kind of community. What are the staff like? Yes,

Dr Carly Roukos 22:06
sounds are lovely. We’re definitely a very close knit team. I think the work that we do at wande is all team based, right? So there’s not any one person here that’s making everybody recover? I mean, obviously, right. But it’s the it’s the whole team, and I think it’s the dietitians, it’s the therapists, it’s the recovery navigators. It’s the chef’s, it’s the cleaners, Darrell, our groundsman, everybody is kind of working together to help. And I think we really, we try and embody that teamwork. And we have a lot of meetings with the staff and the participants, how can we work together what needs to be improved, because that’s how recovery happens, right? It’s not just oh, you just eat a bit more and stop engaging in our behaviours and you’re recovered. It’s about developing connections and community and learning how to engage in healthy relationships. So I suppose the staff really tries to role model that we work quite closely together. And all of the staff that work here are really, really passionate about eating disorder recovery, many of them have recovered themselves. And most people that end up working at one d have really liked myself have kind of sought it out, or they’ve seen the opportunity and been like, wow, that’s something I really want to be a part of. And so I think that helps us well create that environment where we help each other out, we work together, and it’s just kind of one big team as opposed to different individuals all tackling the same problem.

Sam Ikin 23:27
Wow. Yeah. Well, the grounds sound like they’re massive. So shout out to Darrel.

Dr Carly Roukos 23:32
Darrel is amazing. We would not be running without him. He is like, always doing so much for us. He’s helping us get rid of snakes. He’s helping us. You know, he just reached the list this week retrieved a foam aeroplane that the participants had bought and accidentally flown up onto the roof of the building. And they were complaining about that. And one of the groups that I sent asked Darrell how healthy he got his ladder, he got it down.

Sam Ikin 23:56
Now, which were saying before, you’re looking at between one and what was sorry, between that was two and three months, right for for somebody to come and stay. That’s a huge commitment, so if I’m considering attending or you know, that I looking after somebody, and we’re looking at trying to get them in, how can you reassure them that, that everything is going to be as it should be that they’re going to be understood, it’s going to be safe, and this is the place that they should be going?

Dr Carly Roukos 24:26
Yes, yes, you’re right. It is a big commitment. And you know, people often have to leave jobs and families and uni and other things to come here. So I guess leading up to it, we try to have a lot of conversations with them and really explain in detail what to expect from the programme. So all the things that I went over with you today, so they can really get a sense of does this sound like a good fit is something that sounds like it’s going to work for me. And if it’s not, that’s okay. And we will help them to figure out what else might be a better fit. So if someone you know doesn’t have the time or The whatever it is, we’re always going to try to help people find out what’s going to be best for them. But really giving them as much information as we can. We have people sometimes come and have a tour of the grounds just to get a feel for the place. And it’s quite a special place. But, you know, if you’re coming from Interstate, it can be quite scary to kind of pack up and come. So we really do our best to have people feel as comfortable as possible. And really feel like they’ve have all their questions answered, and they understand what they’re getting into. So another good thing to have a look at if you’re interested, or you have a loved one that’s interested is our participant handbook, that’s like a, a book that kind of goes through all of the kind of the ways the programme works and what to expect. And that’s just on our website. If you just Google one to Nerida, you’ll find it on there. So to have a look through that, and I think to kind of really have a think about does it sound like it would be a good fit for me? And is this something that I’ll be able to kind of cope with and deal with? That’s probably the best places to start. But reach out to us as well. Our entire team is happy to have a chat with anybody, even if you just have questions, and you’re not ready to make the commitment. But if you just have questions and wonder, would this be a good place? For me, we’re always happy to have those conversations.

Sam Ikin 26:10
I’ll make sure that we’ve got all the links for everything that anybody needs in the shortest shownotes or the episode description, or whatever it’s called in the app that you’re listening to this in. And look at last question, Carly, there’s the you’ve got a reasonably limited kind of intake, I guess, which is entirely logistical based on the fact that you can fit 13 Yeah. Which is like, it’s phenomenal that people are getting this care. But well, I feel like we could also almost use in a dozen or so more Wandi Nerida’s around the country. Is this something that could be replicated quite easily? And I understand, you know, that’s something that we are trying to do?

Dr Carly Roukos 26:49
Yes. So it definitely can be replicated. And each state is developing their own or is somewhere in the process of developing a residential facility. So there are more on the way. I don’t think there’ll be exactly like one day in terms of the location and things like that it is hard to I guess you have to find a place with a big face and ability to have horses and a Darrell. And those are all hard things to come by. But there are definitely elements of the residential model that can be replicated. And we are working with the other residentials as well, too. And they’re kind of learning from us about what’s worked well so that they can develop what’s going to be most helpful for the residents in their state.

Sam Ikin 27:33
I’m finished with questions. Is there anything else you wanted to tell me or anything we didn’t cover that you think is worth the free plug for you? Whatever you like.

Dr Carly Roukos 27:40
I think the probably the one thing I would love to get out there because I don’t know how known it is is that so we are obviously located in Queensland and we have a contract with the Queensland Government. So we have fully funded beds for Queensland. So that means that if you are a resident of Queensland, you can come to 1d 100% costs covered. So that’s a really great opportunity. Yeah, Ross. And then we also take people interstate as well. And we do have a bursary programme that helps with the financial support. But I guess I just want to get the message out. So that’s for anyone that’s living in Queensland struggling with an eating disorder, this is a really good free opportunity. So definitely have a think about if it would be right for you and or a loved one. And for any referrers out there as well. This is a it’s an opportunity that users can take advantage us.

Sam Ikin 28:31
And let’s hope that these other ones in the other states quick in popping up. It sounds like such a vital service that you provide.

Dr Carly Roukos 28:41
Yes, and I am hopeful in the next couple of years we’re going to see a lot more of these pop up. So definitely there’s a need Australia wide and hopefully we can just reach as many people in Australia and beyond these artists as possible to help people reach recovery and not slip see the gaps as we Tao happens, unfortunately, quite often.

Sam Ikin 29:01
Thank you so much, Carly, I really appreciate your time and your expertise.

Dr Carly Roukos 29:05
Thank you. It’s lovely to chat with you.

Sam Ikin 29:08
To find out more about Wandi Nerida you can go to the website wandinerida.org.au, that’s spelt W A N D I N E R I D A. There you’ll find everything you need to know about one to Nerida and the referral process. And there’s also contact details if you’d like to get in contact to find out a little bit more. If you need support right now the best place for you to start is the Butterfly National Helpline on 1 800 33 4673 That’s 1 800 ED HOPE. Butterfly: Let’s Talk is produced for Butterfly Foundation by Ikin Media with the support of the wonderful Waratah Education Foundation. I’m Sam Ikin