IRELAND’S SYSTEM FOR treating eating disorders has been harshly criticised for pushing people to seek treatment abroad.
It comes as it was confirmed that the HSE will review its plan for overhauling the system following a series of missed targets highlighted by The Journal and other media.
In a response to Holly Cairns, the leader of the Social Democrats, the HSE confirmed that referral rates to eating disorder services have “significantly surpassed predicted demand” following a spike in people seeking treatment in recent years.
The rise in referrals has left long waiting times in some areas, while people living in certain catchment areas cannot access inpatient treatment.
Mary Butler, the minister of state with responsibility for mental health, confirmed to RTÉ’s Prime Time this week that an average of six people per year have accessed eating disorder treatment services in the UK over the last nine years.
“When we spend money to send people abroad, we’re sending a large amount of money to the private sector,” Dr Art Malone, a psychiatrist and eating disorder specialist at St Vincent’s Elm Park hospital, told The Journal.
Malone, who is also the vice-chair of the eating disorders special interest group at the College of Psychiatrists of Ireland, said the money “is being spent one way or the other”, but it is not being used “in the most useful way”, which would be to develop Ireland’s eating disorder services so people do not need to seek treatment abroad.
“It’s the age-old habit of Ireland exporting people to the UK for healthcare,” Holly Cairns told The Journal.
“It is a classic shortcoming in Irish healthcare. And the people in the state where they need to seek treatment abroad tend to be very unwell. It highlights how ridiculous the situation is.”
In 2018, the HSE rolled out its plan to overhaul eating disorder treatment services via the model of care (MOC). The plan had two key aspects.
First, 16 ‘hubs’ would be opened to offer treatment to people with eating disorders in community settings across Ireland.
Second, new inpatient beds would be opened for the smaller number of people who were too unwell to be treated in the community.
The services would operate on two pathways – one for under 18s, the other for adults.
It is planned that eight new beds for under 18s will be opened as part of the new National Children’s Hospital. However, as revealed by The Journal earlier this week, no funding has been provided for the adult beds. There are just three public adult beds in Ireland, despite plans to open 20 more by 2023.
The HSE also confirmed it missed the MOC targets for the 16 hubs. While they were all to be opened as of the end of 2023, just 11 are currently operating.
The health service has now confirmed that the MOC is being reviewed, due to the rise in population and eating disorder referrals since the MOC was first drawn up in 2016.
“Referral rates to existing community eating disorder teams have significantly surpassed predicted demand and capacity estimates made prior to the pandemic,” the HSE said in response to a parliamentary question from Holly Cairns.
“Given this increase in demand for eating disorders services, and the recent preliminary census 2022 data showing an overall increase in population, a review of the eating disorder model of care is planned during 2024.
“The outcomes of this review will inform the eating disorder teams’ staffing requirements from 2025 onwards.”
The HSE said the MOC review will include examining the resources required “based on population increase and demand for service over the past five years”.
“A funding stream and provider have to be identified to complete this significant body of work,” it said.
Cains said the plans reflect a lack of “urgency” from the government towards eating disorders.
“The MOC was meant to be done in 2023, so why wasn’t this review done last year?” she said.
“The fact that we still just have three adult beds in Ireland and we have people setting up GoFundMes to get the care they need is completely unacceptable.”
Speaking to RTÉ’s Prime Time, Butler said there had been an improvement in eating disorder services in recent years, pointing to the rollout of the community teams.
“When I came in [to government in July 2020], we had one team. We now have 11,” she said.
Whether we need 20 beds on top of the three we already have is going to be looked at.
“I don’t think we need more because 90% of all supports being provided for people with an eating disorder are in the community.”
While medical professionals agree the best treatment for eating disorders is in a community setting, Cairns said it should not be an “either/or situation”.
“The minister should be focused on the two very much needed services: community and inpatient. People need both,” she said.
Malone said that while community treatment was preferable, inpatient services are also important for the smaller number of people who need them.
“I would have concerns that if you are being treated in an area that doesn’t have access to specialised care, you are losing out,” he said.
“For people who need inpatient treatment anyway, it tends to be more expensive and traumatic [if they travel abroad or go private] and by the time they do get access to care, they need more care.”
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