Paul O'Donoghue

HERE’S stating the obvious – Ireland’s health system has a few problems.

Access to care is perhaps the one which gets the most attention, and deservedly so. Patients are often left waiting months for serious procedures, even years in some cases.

However, as bad as this is, there is at least normally a pathway for treatment.

But for many adults in Ireland who suffer from eating disorders, this does not exist. At least, not in the public system.

There are only three public inpatient beds offering specialist treatment for adults in the entire country. And these are only available to people who live around the Dublin area.

This has been the case for the last 20 years or so. It was meant to be fixed with the ‘Model of Care’ (MOC), a plan to improve eating disorder treatment services nationwide.

As part of this, about 20 new adult beds were supposed to be opened between 2018 and 2023. Not only were none provided, but no funding was even put towards the measure.

Carers

This week, CARED Ireland, a voluntary group representing parents and carers of people with eating disorders, highlighted how this has a devastating impact on patients.

They were speaking before the Oireachtas Health Committee, which was told that these beds are likely still some way off.

Dr. Amir Niazi, a National Clinical Adviser and Group Lead for Mental Health at the HSE, said officials are “hopeful that these beds will start coming on stream in the next three to five years”.

This means we are likely talking 2029 at the earliest for even the first of these beds – when they were all meant to have been delivered by 2023.

The timeline is not something which Dr. Niazi can control – he was just the messenger, and is one of those working to improve mental health services.

The responsibility lies with the HSE itself, which has presided over a frankly terrible wait for those suffering from the condition and their families.

Anorexia accounts for the vast majority of eating disorder hospital admissions. It has the highest mortality rate of any mental illness. Someone with the condition is multiple times more likely to die compared to the general population.

But only about 6% of adults with the condition who are admitted to hospital get specialist inpatient treatment.

And that 6% likely refers to people in the catchment area for the three beds we mentioned earlier.

For adults with eating disorders who don’t live there (ie, almost anywhere outside Dublin) their chance of getting specialist inpatient treatment in the public system is likely close to 0%.

It’s hard to conceive of this happening with any type of physical illness, such as cancer or a heart issue.

As much as Ireland likes to talk about how much it has improved when it comes to mental health treatment, it has consistently failed to provide care for those struggling with the mental illness most likely to kill them.

Small steps

But if the HSE didn’t provide any beds during the MOC timeline – what did it do?

This is where it is worth acknowledging improvements.

The MOC was essentially split into two main components – improving inpatient and outpatient services. For inpatient, this is largely about delivering more beds.

For outpatient, it is mainly about building 16 new treatment ‘hubs’ – eight for adults and eight for children and teenagers.

These provide specialist outpatient support to those with eating disorders. Conditions like anorexia are most effectively treated in a community setting.

The idea is these hubs will improve care in that area, and mean that most patients will never need inpatient care. It’s a good approach. But there are two issues.

Numbers of promised bads have not been met. Alamy Stock Photo Alamy Stock Photo

One – the hub rollout is patchy. The 16 centres were meant to be up and running by the end of 2023. To date, only 11 are operational.

This still is a vast improvement over the situation in 2018, and is worth celebrating. But it means there are still big chunks of the country -approximately 14 counties- which have no specialist treatment in the community.

Dr. Niazi told the Oireachtas Health Committee that the planned 16 teams should be in place “by the end of this year”.

Many will likely still not be fully staffed – but again, it will be a vast improvement.

“We will have 16 teams to take on all these eating disorder patients,” he said.

He said “95%” of eating disorder patients can be treated in a community setting, while only a “very small 5% need inpatient care”.

It’s also worth noting that this community-focused approach to care seems to be very effective – particularly when it happens at an early age.

Many of those who receive outpatient care via specialist CAMHS (Child and Adolescent Mental Health Services) treatment make a full recovery, and don’t need to be transferred to AMHS (Adult Mental Health Services).

Dr Michelle Clifford, the National Clinical Lead for Eating Disorders, said: “Approximately 10% of those attending CAMHS eating disorder teams will require transition to an adult eating disorder team. It is the minority.”

I work in a can specialist eating disorder team. Of the 70 open cases that I saw in the last year, just three young people required transfer to the adult eating disorder team.

“The majority of young people, 95% will recover from outpatient care. Only 5% will require admission to hospital. It’s one of the great myths actually around eating disorders, that recovery isn’t possible.”

This is all excellent, and it is extremely encouraging to see the improvement in outpatient care. But this is where we come to our second problem. What about that percentage of people who *do* need inpatient care?

There has been an improvement in CAMHS, with more inpatient beds on the way. But for the adults, as discussed – there has been nothing.

While the number of people affected is relatively small, it certainly isn’t insignificant. In 2022 (the most recent figures available) adult hospital admissions for eating disorders rose to 210 – the highest level in a decade.

It’s a number which has been consistently increasing, and will likely continue to do so as the population grows.

Talking about the improvement in community services is cold comfort to this group. The lack of options for inpatient treatment has led to appalling situations such as women launching GoFundMe campaigns to get access to private care.

This has happened multiple times, with desperate patients and their families forced to launch public appeals in an effort to get treatment.

Ireland’s eating disorder treatment has undoubtedly improved, and the community hubs are a great step forward which will treat the majority of patients.

But for too long, officials have done nothing to improve inpatient care for adults.

These are the eating disorder patients who are the most sick. The ones who face the highest risk of death, and who most need specialist treatment.

They deserve better than to be ignored.