THE HSE HAS spent €13.5m sending eating disorder patients abroad since 2016, while no funding has been allocated for new public adult inpatient beds in Ireland.

The HSE has confirmed to The Journal that €4.5m was spent on access to treatment for eating disorders under the Treatment Abroad Scheme (TAS) in 2023.

The spending on the TAS has been rising annually since 2018. Some €715,000 and €390,000 was spent in 2016 and 2017 respectively.

In 2018, just under €320,000 was spent funding eating disorder care under the scheme.

This increased to just over €800,000 the year after, then almost €1 million in 2020 before jumping to €2.6 million in 2021 and further rose to €3.2 million in 2022 before hitting €4.5 million in 2023.

The growing spend comes while no funding has been provided for new adult inpatient beds in Ireland, despite new beds being a HSE aim.

Social Democrats leader Holly Cairns said while it was crucial that those who need help received it under the TAS, the figures showed that the government’s approach to funding eating disorder care is skewed.

“We cannot keep exporting extremely sick people, who are in deep distress, for treatment – at huge cost to them personally and the state financially,” she told The Journal.

The €4.5 million spent on the TAS in 2023 also came in the same year no additional funding was allocated to the eating disorder model of care (MOC), a national plan to improve services across Ireland.

“There was no additional new development funding [for the MOC] in 2023. Additional 2024 development funding is due to be confirmed by the Department of Health,” the HSE said in a statement.

Those who receive treatment for eating disorders under the TAS are among the most unwell patients who require inpatient care. 

This is generally not available in Ireland, with just three public beds for adults in the country. These three beds can only be accessed by people living in a certain catchment area, meaning people in most of the country have no access to specialist inpatient services.

Many patients therefore are left to access private services, however this can cost tens of thousands of euro.

Those who are not covered by insurance or cannot afford the fees for private inpatient care in Ireland often seek treatment in the UK under the TAS.

The situation was meant to be improved under the MOC, a national plan which was to be rolled out between 2018 and 2023. It had two key strands, one focusing on community care and the other on inpatient services for children and adults.

Community care

Funding was first set aside for the MOC from 2016. Figures provided to The Journal show €8.1 million was allocated to the plan between 2016 and 2023, although no funding was allocated in several individual years, such as 2023. 

This money was spent rolling out community eating disorder teams – 12 of 16 such planned teams have been established.

However, The Journal recently revealed that despite an aim in the MOC to open 20 adult inpatient eating disorder beds between 2018 and 2023, no funding was provided for this. 

Medical professionals have said the state’s approach does not make financial sense, as the decision not to invest in inpatient services in Ireland has resulted in higher costs sending eating disorder patients abroad.

Dr Art Malone, a psychiatrist and eating disorder specialist at St Vincent’s Elm Park hospital, previously told The Journal: “For people who need inpatient treatment anyway, it tends to be more expensive and traumatic [if they travel abroad] and by the time they do get access to care, they need more care.”

The government has said it is prioritising the rollout of community services under the MOC as these services benefit the majority of people with eating disorders.

“90% of eating disorder services are now delivered within the community which research shows is the most effective treatment,” Mary Butler, the mental health minister, recently told the Dáil.

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Just under 400 people were diagnosed with an eating disorder in 2022. Medical staff have said the vast majority of people with eating disorders are better served receiving treatment in a community setting.

However, Cairns said the smaller number of people who require inpatient services still need treatment.

She added that the €13.5m spent on sending patients to the UK under the TAS compared to just €8.1m improving Ireland’s own services under the MOC show that the state’s approach represents poor value for money.

“It is shameful that this is an area of the health service that is constantly under-resourced despite eating disorders being among the psychiatric conditions most associated with mortality,” Cairns said.

When is the government going to actually deliver on its promises to properly resource these critical and lifesaving services?”

Bodywhys, the Eating Disorders Association of Ireland, said that pushing those with eating disorders to seek treatment in the UK “presents additional challenges to both the individual and their loved ones”.

“It is a huge upheaval to a person’s life – sometimes for long periods of time – and can contribute to feelings of isolation from family and friends, and increased stress of unfamiliar surroundings, far from home,” the organisation said in a statement to The Journal. 

Bodywhys also said that even those who receive funding under the TAS often are often still put under “significant financial strain”. 

While the cost of care for patients is covered, parents travelling with their children reported losing money due to taking time off work as well as covering expenses such as travel and accommodation themselves.

There has been a significant rise in demand for eating disorder services in Ireland. In 2022, there were 210 hospital admissions for eating disorders, the vast majority of whom were women. This was the highest level of admissions in a decade.

The HSE has 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.