LAST UPDATE | 24 Apr
NO FUNDING WAS provided over the last six years to open adult eating disorder treatment beds, the HSE has confirmed.
This means that a plan to open 20 new beds by 2023 went completely unfunded.
Ireland currently has just three public beds in the entire country which offer specialist treatment for those with eating disorders.
Under the HSE’s model of care, a plan to overhaul the country’s eating disorder services, an additional 20 beds were to be opened between 2018 and 2023.
However, the organisation has now confirmed that no new funding was provided for this.
The only existing public specialist eating disorder treatment beds for adults in the state are three located in St Vincent’s University Hospital in Dublin.
People impacted by eating disorder outside of the catchment area for these beds who go into public hospitals are normally referred to a general psychiatric unit, where they often do not receive specialised care.
“There has been no new development funding for further specialist eating disorder beds,” the HSE confirmed in a statement to The Journal.
Raising the issue today during Leaders’ Question in the Dáil, Social Democrats leader Holly Cairns said it seems the Government does not understand how serious eating disorders are.
“Over the years I’ve spoken to women who’ve been forced to speak publicly about what they’re going through. To set up GoFundMes to get the care that they need.
“I’ve spoken to parents are at their wit’s end watching their children quite literally waste away, in disbelief that there’s no support for them.
I’ve spoken to people who work over in the NHS who are seeing Irish women coming over at death’s door because they can’t get the care they need at home.
“That reality doesn’t seem at all represented in the Government’s response,” she said.
In response, Taoiseach Simon Harris said he wanted to assure the deputy that he is committed to enhancing specialist services for eating disorders.
He said he agreed that historically there has been low investment in public provision of eating disorder services in the State.
He said he intends to see progress on investment in the next Budget.
Dr Art Malone, a psychiatrist and eating disorder specialist at St Vincent’s Elm Park hospital, said the result was extremely disappointing and comes following consistent reports of significant spikes in eating disorder hospital admissions.
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.
That year, ”timeframes for the new beds” were still to be identified, according to Minister of State for Mental Health Mary Butler, when asked about their progress by Noteworthy.
Many people who spoke to Noteworthy during their investigation at the time, spoke of the thousands they or their parents spent on inpatient care due to lack of public beds.
The lack of new beds “has major implications for people with eating disorders and people providing these services”, Malone told The Journal.
“Just because there are no beds, doesn’t mean the demand isn’t there,” he said, adding that the HSE often ends up paying for people with eating disorder to access private facilities.
“The money is being spent one way or another – it’s just not being spent in a useful way.”
The HSE’s model of care planned to modernise the country’s eating disorder services between 2018 and 2023, inclusive.
However, as previously reported by The Journal, the plan was often unfunded. While €8 million was provided under the plan, no funding for new services was provided in 2020, 2021 or 2023.
The two main areas of focus were ‘treatment hubs’, for providing care in the community, and the specialist beds, for when someone was too ill and needed to go inpatient in a hospital.
Although the HSE missed its target of opening 16 new treatment hubs by the end of 2023, it has opened 11 and has pledged to open the remaining five. Approximately 80 staff have been hired to date, with funding in place for an additional 20.
However, no progress has been made on providing new inpatient beds.
While it is planned that eight new beds for under 18s will be opened as part of the new National Children’s Hospital, no funding has been provided for the adult beds.
Defending the decision, the HSE said it has focused on the new treatment hubs.
“Funding for specialist eating disorder services is focused on developing regional community-based specialist services,” it 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.
“Adults who have an eating disorder diagnosis and require inpatient care can be referred to any of the HSE’s acute inpatient mental health approved centres around the country.”
Malone, who is also the vice-chair of the eating disorders special interest group at the College of Psychiatrists of Ireland, said it was true that the preference is to treat people with eating disorders in the community.
However, he added that this does not mean that inpatient services can be discounted.
“There is lots of evidence that inpatient treatment is beneficial (if needed),” he said.
“We’re talking about people with severe eating disorders who haven’t been able to manage outside of hospital.
For that group, specialised treatment is necessary.
“Most people benefit better from recovering in a community environment. But for the people who are the most severely unwell, it [being an inpatient] is the only way to treat them.”
Increasing public eating disorder bed capacity has been a commitment of state policies since ‘A Vision for Change’ in 2006 recommended the state develop 24 adult eating disorder beds. This was then revised to 23 in the ‘Model of Care’.
Eating disorder experts say the number of extra beds needed has now likely increased, given population growth since 2016, when the ‘Model of Care’ was launched, and the number of extra people seeking treatment.
Those unable to get help in the public system are forced to seek treatment privately. For those who are uninsured, treatment costs can run into tens of thousands of euros.
The lack of investment is despite the fact that anorexia has the highest mortality rate of all mental illnesses.
Malone said that a particular issue with funding new inpatient beds is that they could require completely new areas to be developed in hospitals.
“It’s possible that rather than having a few new beds here and there, you could have large regional centres, but I haven’t seen any plans for that,” he said.
“But there is no evidence that demand for beds will go down. We’ve only seen increased presentations and increased severity of illness in the last few years, so if anything the number of beds we actually need will probably be higher.”
With reporting from Jane Matthews
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