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Investigation

HSE missed deadlines to open 5 critical eating disorder treatment hubs

Some €1.4 million of an allocated €8 million funding remains unspent.

THE HSE HAS missed a deadline to open five critical eating disorder treatment hubs.

The state body had set a target of opening 16 centres – eight for adults and eight for children – by the end of 2023.

However, it has now confirmed that just 11 are in place. Of this number, the centres are at varying stages of development and not all 11 are fully staffed.

The centres were to be rolled out under the Model of Care, a HSE plan which was to overhaul the country’s eating disorder treatment services.

However, financial backing for the plan has been unsteady. No funding was made available for developing new eating disorder services in 2020, 2021 or 2023.

The 16 treatment hubs are the focus of the plan, with each one staffed by a team including the likes of psychiatrists, nursing staff and dieticians. 

As eating disorders are illnesses which health staff prefer to treat in a community setting, the idea of the hubs is to reach patients before they become more ill and need inpatient care.

However, the delays in rolling out the hubs mean that some parts of the country are essentially left without any specialist treatment. For example, no hubs have been rolled out in CHO 3, consisting of Clare, Limerick and north Tipperary.

In a statement, the HSE said: “The most effective treatment setting for eating disorders (EDs) is usually in the community, although a small number of people benefit from more intensive treatment through day programmes or inpatient care.

“There are currently five of these specialist CAMHS (Child and Adolescent Mental Health Service) teams and six adult teams at various stages of development across the HSE.”

Protests took place in Dublin, Cork and Limerick earlier this month highlighting the lack of eating disorder services across the country.

Increase in demand

It came amid a sharp rise in the number of people seeking treatment, with the Health Research Board publishing figures last year showing that the number of child and adolescent admissions for eating disorders jumped from 33 in 2018 to 80 in 2022.

The HSE highlighted that €8 million in funding has been made available for the development of eating disorder services since 2016, even with no new funds allocated in several years.

The funds were to be used to hire almost 100 staff. 

However, as this target has not yet been reached, some €1.4 million of the allocated €8 million funding remains unspent.

“Over 80 of those roles had been filled as of November 2023, prior to HSE recruitment pause,” the HSE said in a statement.

While there has never been detailed research on the cost of eating disorders in Ireland, a study in the UK estimated a minimum cost of £1.26 billion (€1.47 billion) in areas such as healthcare costs.  

Fiona Coyle, the chief executive of Mental Health Reform, said it is widely acknowledged that Ireland’s eating disorder model of care “has not been rolled out in line with what was originally thought”.

She said a further issue is that the model of care was drafted up around a decade ago, when population growth estimates were much lower.

Because of this, even when all 16 centres are operating and fully staffed, the level of services offered still may not be enough to meet demand.

“Our Census shows we have a bigger population than we thought. To add to that, since Covid happened, there is evidence that there’s been increasing presentations of eating disorders,” she said.

“While there has been funding increases (compared to before the model of care), as an overall percentage of the healthcare budget, funding for clinical programmes such as for eating disorders has not increased over the last five years.”

Earlier this week, The Journal revealed no funding was provided over the last six years to open adult eating disorder treatment beds.

Tonight, RTÉ Prime Time is broadcasting a special report on Ireland’s failure to deliver services to both children and adults with eating disorders. 

Echoing Coyle’s statement, Professor of Child and Adolescent Psychiatry, Fiona McNicholas told RTÉ: “Post Covid, what we saw was an increased referrals of eating disorder internationally. They referred to it as a tsunami of eating disorders, and we saw that again here in Ireland.” 

The investigative team spoke to a number of people impacted by the lack of services. Lauren Gaffney told reporter Conor Wilson that her eating disorder was a compulsion driven not by body image or a desire to be thin.

“I didn’t fuel myself enough for the amount of things that I was doing every day,” she explained. “That’s how I was coping with life. And unfortunately, restriction became my coping, my existence.”

Her treatment plan is made more difficult because of certain restrictions around BMI. 

“I’m unwell and I’m struggling, and I need support, but yet I’m not at a heavy enough position in order to receive support. Our (mental) health professionals will only engage with me if I’m a certain BMI.

“I need the help and support to increase my weight to get to the BMI, but there is nobody there who can offer me that support unless I go, and I present myself to a hospital and be put on a medical ward for refeeding. Because I’m not heavy enough, but I’m too sick for support… My threshold is not the magic number to receive help and support.” 

Prime Time airs tonight at 9.35pm.

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