Ms Jacinta Hastings:

Dia is Muire daoibh, a chairde. I thank the Chair for inviting us here today. I am CEO of Bodywhys and I am joined by my colleagues, Ms Harriet Parsons, training and development manager and Ms Kathy Downes, support services manager.

As the committee may be aware, Bodywhys, founded in 1995, is the national voluntary organisation providing support services to people affected by eating disorders, including family and friends.

Our vision is that people affected by eating disorders will have their needs met through the provision of appropriate, integrated, quality services being delivered by a range of statutory, private and voluntary services.

Our mission is to provide support to people affected by eating disorders; promote information, education, training and awareness among the wider community; and advocate for rights and healthcare needs of people with eating disorders.

Eating disorders - anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, ARFID, and related issues - are a group of recognised mental health conditions that have the highest mortality rate of all mental illnesses.

The Department of Health estimates that up to 180,000 people in Ireland are affected by eating disorders with up to 1,800 new cases occurring each year. The average age of onset is 15. There is no one cause of an eating disorder developing as the causes are a mixture of biology, psychology and social factors causing psychological and physical complications, and some of these are life threatening.

For anorexia nervosa, the peak incidence of onset is 14 to 18 years and for bulimia nervosa, it is 14 to 22 years. Binge eating disorder most commonly presents in the late teens or early 20s. However, with early assessment and evidence-based treatment, people can and do recover from eating disorders.

Since the onset of the pandemic in 2020, the number of eating disorder presentations and the severity of those presentations have increased substantially. The full scope of the adverse impact of the pandemic on people with eating disorders is not yet known. Treatment adaptations and safety issues, a sense of confinement from being at home, along with decreased protective factors against eating disorders, exacerbated barriers to care, and increased eating disorder risk and symptoms, are some of the challenges that have been identified to date.

Bodywhys services also have experienced a significant increase across all support services, which my colleague, Ms Downes, will expand upon. Bodywhys offers a range of services to support people with eating disorders, including a helpline; an email service; online support groups, BodywhysConnect and YouthConnect; a free online psycho-social programme, SeeMySelf, addressing self-esteem; and body image and media literacy. The Bodywhys peer led resilience, PiLaR, programme is a free four-week education and skills programme for family members supporting a person with an eating disorder and we have recently introduced the new Maudsley skills-based training for families. My colleague, Ms Parsons, will elaborate on these services.

The Bodywhys website, , provides a wide variety of information on eating disorders, treatment options and support services and is regularly reviewed to incorporate the most up-to-date information and resources, including, for example, Eating Disorders – a Treatment Guide; a resource for parents/families; GP booklets developed in association with the Irish College of General Practitioners; pharmacist guide in association with the Irish Pharmacy Union; and a resource for dentists in conjunction with the Irish Dental Association.

A common feature of an eating disorder is low self-esteem and negative body image. Research in Ireland indicates that body image is a widespread issue for young people, body image and related concerns are on the rise in both males and females and, worryingly, rates of eating disorders are rising in pre-teens. It is important that teachers in schools are aware that such issues can occur in schoolchildren and that they are equipped to deal with any such issues which may arise. Bodywhys has developed school-based interventions to promote positive body image, self-esteem and media literacy as well as on-site workshops for the entire school population - students, teachers and parents.

The policy document entitled A Vision for Change: Report of the Expert Group on Mental Health Policy of 2006 made specific recommendations to address the issue of eating disorders. Ireland’s current national mental health policy, Sharing the Vision: A Mental Health Policy for Everyone, aims to enhance the provision of mental health services and supports across a broad continuum, from mental health promotion, prevention and early intervention to acute and specialist mental health service delivery, during the period 2020 to 2030. The recommendations in the 2006 policy on eating disorders were carried over to the subsequent policy, Sharing the Vision: A Mental Health Policy for Everyone. The recently-launched Sharing the Vision Implementation Plan 2022 to 2024, the first of three planned implementation plans, outlines a programme of work for the next three years to progress the 100 policy recommendations. Its delivery will be driven by a focus on outcomes and a shared commitment to work in partnership with staff, service users and families and all relevant stakeholders to meet the needs of those who require mental health services. In relation to eating disorders, the recommendation in the implementation plan reads: "Continued phased implementation and evaluation of existing national clinical programmes in mental health – including... Eating Disorders." We can see, from these policies and implementation plans, that there has been some progress in actions on eating disorders services, albeit somewhat slow progress.

Eating disorder patients are seen across a range of services, from GP and primary care to referral on to specialist service either in the public or private sector. In the public sector, in January 2018 the HSE launched the National Clinical Programme for Eating Disorders, NCP-ED. The NCP-ED aims to provide timely, high-quality services and care in Ireland at all stages of eating disorders. This includes evidence-based treatment, dedicated eating disorder treatment teams and a stepped model of care for children and adolescents, and adults and families. This, in effect, is a national strategy for the treatment of eating disorders in Ireland. The plan is to roll it out on a phased basis across the country. In the private sector, there are individual practitioners as well as private inpatient and outpatient services, for example, in St. Patrick's Hospital; St. John of God Hospital; Lois Bridges, the national eating disorder recovery centre; and the Eating Disorder Centre Cork. Bodywhys endeavours to foster and collaborative approaches with all services, relevant agencies, organisations and other stakeholders.

Finally, Bodywhys would like to thank the Sub-Committee on Mental Health for its support of people with eating disorders. We would also like to acknowledge the Minister of State, Deputy Butler, for her continued interest in, and support of, eating disorders. As outlined earlier, the increase in the presentation of eating disorders as a consequence of the pandemic has made it a critical issue for patients requiring an urgent response. We ask for the support of the committee in the following key proposed areas relating to eating disorders which form the focus of our contribution today. The feedback from families and those with eating disorders is that they experience differences in areas with and without eating disorder teams. Where eating disorder teams are in place, there is a positive outcome for the patient. Areas with no teams in place contribute to an inequity of access, further compromising the health of those who require treatment. The increase in the presentation of eating disorders has inevitably led to an increase in waiting times in areas with eating disorder teams. All of this highlights the need for funding for full team recruitment as per the model of care, and the need for the model of care to be reviewed and updated to take account of increased demand. Funding should be provided on a bi-annual basis, rather than an annual basis, to allow for advance planning of services and supports. The development of a national eating disorder registry would provide factual data, allowing for the future-proofing of services. We urge the committee to ensure that eating disorders remain a priority within its discussions on mental health.