Despite an increase in the frequency and severity of eating disorder cases, there are fewer than 30 dedicated beds. Michelle McDonaghreports
Since Prof John Griffin began working in the area of eating disorders 30 years ago, he has witnessed an increase in the frequency and severity of cases of anorexia, bulimia and binge eating disorder in Ireland.
Griffin is director of the eating disorder programme at St Patrick's Hospital in Dublin and a consultant psychiatrist.
Even more disturbing is the changing age profile of patients, with children as young as nine presenting to the paediatric hospitals. There is also an increase in males presenting for treatment.
Up to 200,000 people are estimated to have an eating disorder in Ireland, yet there are fewer than 30 dedicated inpatient eating disorder beds in the State - only three of which are public - and they are all based in Dublin.
There are 16 private beds at St Patrick's Hospital, eight private beds at St John of God's and three public beds at St Vincent's Hospital, Dublin.
There seems to be a general consensus among medical professionals, parents and politicians that the national stock of inpatient beds available for eating disorders is woefully inadequate.
The Government's Vision for Change: Report of the Expert Group on Mental Health Policy 2006 has identified major gaps in the provision of services for people with eating disorders.
The report contains many recommendations for change including four new specialist eating disorder teams for adults, one in each of the HSE administrative areas. The report also recommends that each HSE area should have an eating disorder six-bed sub-unit, representing 24 eating disorder public beds nationally.
The outlook in terms of the development of services for people with eating disorders is much more optimistic than in the past, but these recommendations will take up to 10 years to implement and, in the meantime, young women will continue to die needlessly, according to those working in the area.
The Bodywhys eating disorder association helpline received more than 3,000 calls last year - a 38 per cent increase on the previous year. In Cork, a group of concerned parents has launched a campaign calling on the HSE to open a dedicated outpatient facility for adolescents with eating disorders. They claim their children's lives are in danger because of the lack of services in the southern region.
Meanwhile, Minister of State at the Department of Justice, Equality and Law Reform, Frank Fahey, is calling for the establishment of an outpatient clinic for the treatment of eating disorders in Galway. "This very serious and prevalent illness has not been addressed in this country. I have come across a number of people in Galway in recent times who suffer from this condition and I have seen the misery that their illness is causing them and their families. People have to travel from the west of Ireland and the rest of the country to Dublin for treatment and this is simply not good enough," he says.
When Griffin began working at St Patrick's in 1972, there were only three beds in the State, and these were at St Vincent's. He opened an eight-bed unit in 1985 which was extended to 16 beds last year, to become the largest eating disorder unit in the Republic.
"In the early 1980s I went to all of the health boards in Ireland and talked to various people about setting up regional eating disorder units but there are still no dedicated eating disorder beds outside Dublin today, including Northern Ireland," he says. "There is a need for dedicated regional eating disorder centres in Cork, Galway and other areas that are properly staffed on a holistic multidisciplinary basis."
When Griffin set up the unit at St Patrick's, he was seeing girls in their teens presenting for treatment, but his colleagues in the paediatric hospitals tell him they are now seeing children as young as nine with eating disorders.
"Television programmes, films and MTV are conditioning kids to be slimmer at an earlier age. Girls are reaching puberty earlier and are reading magazines not appropriate for their age which tell them how to get slim," says Griffin.
"Most sinister of all are the sites on the internet like Pro Ana and Pro Mia which not only provide tips on how to perpetuate eating disorders, but encourage people to choose anorexia or bulimia as a lifestyle choice."
The solution to the problem, according to Griffin, is prevention and education. He thinks the Departments of Education and Health should co-ordinate the introduction of a teaching programme aimed at children in fifth and sixth class of primary school - he used to recommend this intervention at fifth and sixth year in secondary school.
Eating disorder clinical nurse specialist at St Patrick's, Toni O'Connor, says the waiting list at the unit has been reduced to about four weeks since it expanded. After initial assessment, patients spend an average of four weeks as inpatients and eight weeks in day care with a year's follow-up treatment.
O'Connor agrees that eating disorder facilities in Ireland are minimal and with mortality rates worryingly high in anorexia, more facilities would result in better outcomes and fewer deaths. Research has shown that the earlier people with eating disorders get treatment, the better the prognosis.
Jerry Campion of the Marino Therapy Centre in Dublin, a private outpatient facility dealing with people with and recovering from eating disorders, says he has seen too many people suffering and dying needlessly from eating disorders in Ireland because of the lack of facilities.
He says people from all over the country, north and south, travel to the centre in Dublin for counselling. At the moment, they are seeing 200 people a week and have a six-week waiting list.
"Eating disorders can be dealt with successfully but the recovery period is usually lengthy. Providing four walls and a roof is the easiest part, the real problem is staffing these facilities. What is needed to start is one facility in each province, fully staffed with a multidisciplinary team who understand the problems of eating disorders. It's not just a matter of stopping purging and bed rest," he says.
Campion is disgusted that there are still people in the Republic being given electro shock treatment for eating disorders and being asked to parade in front of mirrors in their swimsuits. "It does not make sense. Neither does the reward system where, if you don't co-operate, you are dismissed from hospital and sent home to die. I have been told of this happening by parents of children who have died.
"It's extraordinary to deal with somebody with an eating disorder in this way. If somebody goes into hospital looking for help, I think it's up to the professionals to provide that help, not to send them home because they won't co-operate."
The director of the HSE's mental health services, Martin Rogan, agrees that the mental health services in Ireland were virtually abandoned for a very long time, but he says the introduction of new legislation, policies and investment in the past 12 months has led to a new confidence in the services.
"We are investing €750,000 in specific services for eating disorders this year, including €500,000 for a brand new six-bed unit at the national eating disorder centre at St Vincent's and €250,000 on the development of services for young people with eating disorders in the HSE south. This is probably the biggest formal investment in eating disorders as a specific group ever," he explains.
Rogan says he is confident the Vision for Change recommendations will be put in place. The work has already begun in Dublin and is now starting in Cork, he says, and the development of services in the other two HSE areas will follow.
The Vision for Change report recommends that services for children and adolescents with eating disorders, should be dealt with within the child and adolescent mental health services as is the current situation. For the "small number" of children and adolescents who require specialist input beyond this, the report advises that a National Centre for Eating Disorders should be established and located in one of the national children's hospitals.
The report also highlights the need for greater public awareness of eating disorders at community and family level and health-promotion initiatives that support better awareness.
Noting that GPs in the Republic lack education in the field of eating disorders, the report suggests this deficit be addressed in undergraduate and ongoing medical education.