Dr. Brendan Doody:

There are 76 beds which are either HSE beds or HSE-funded. The number has dropped with the Linn Dara unit having to reduce its capacity. The number of currently available beds is less than 50. On the issue of staffing and being obliged to close beds, I want to reassure the committee that everything that could possibly have been done within the service to ensure that those beds were kept open was done. They were kept open for as long as it was feasible to do so, and it is hoped that the closure will be for the shortest time possible. It is hoped the beds will reopen in October. While the unit was operational after it opened on schedule in December 2015, its bed occupancy was between 90% and 100%. That is also the current rate of occupancy.

I was asked about the range of inpatient services. All the 76 beds that are currently available are what would be called generic or open units. Inpatient services require not just those units, but also low and medium-secure units. This was acknowledged within A Vision for Change. A specialist eating disorder unit is also required. Those units are in development. The eating disorder unit will be part of the new paediatrics hospital and it will be a number of years before that will be available. The hospital will also have an eight bedded generic inpatient unit. There will be 20 additional beds on stream with the completion of the new national paediatric hospital. In the interim, a particular challenge has been that we are seeing increasing numbers of children with eating disorders being admitted into the generic units. On average, one third of our beds in our unit are occupied by young people with very severe eating disorders at any time.

I was asked what are the consequences of the absence of these units. It means that some young people have to access medium-secure psychiatric services or specialist inpatient eating disorder services outside of the State. That number is lower but it will remain the case until those services are available. A secure inpatient facility is being developed in Portrane as part of the redevelopment of the national forensic services. There is a ten-bed adolescent secure unit to be developed. We are looking at a timeline of about three years before that unit is open. There are plans to develop these units.

To increase the capacity to support children with eating disorders, a clinical treatment programme was recently launched with a plan to roll out specialist community eating disorder services, which will be quite intensive and will have both outpatient and intensive day-patient components. That is what is happening in the interim but the absence of secure beds also means that some young people will be admitted or remain in adult units. One must remember that to admit a young person onto an open unit we must bear in mind the therapeutic milieu of the unit. We may have young people on that unit who are 13 and 14 with anxiety disorders and eating disorders. We have to remember the impact of admitting a very unwell, disturbed young person onto that and we have to think about the impact on other young people. Other young people on the unit may feel quite threatened by that and feel unsafe, which might have an impact on their own treatment programme. When we are looking at admitting, the whole issue of placements must be considered.