Ms Harriet Parsons:

The Deputy mentioned treatment services and referred to counselling. I would say psychotherapy, because it is an unregulated field for private practitioners. We are conscious of the distinctions that are made between counselling and psychotherapy, that are mainly based on years of education etc. On the treatment services, looking at the model of care, we can see the HSE has looked internationally and at the National Institute for Health and Care Excellence, NICE, guidelines in respect of evidence-based treatments within a publicly funded specialist eating disorders service. They are the treatment approaches that are best used and serve the community best. The HSE has chosen the treatment approaches that are within those guidelines. For adults, the treatment is enhanced cognitive behaviour therapy, CBT-E, and for adolescents and children, it is family-based therapy, FBT. They are the first-line treatments that are offered.

I think it was around ten years ago that the HSE embarked on training clinicians within the health service to be able to deliver those treatments within the specialist teams. There are different disciplines within the specialist teams. For example, there could be a clinical nurse or a social worker who is trained in CBT-E and will be delivering it. People are employed under a certain discipline and they are trained in the competency of the treatment approach.

One of the problems arising is in terms of staff turnover and being able to ensure that, nationally, the people who have been trained in these specific treatment approaches remain in the service to deliver what they have been trained to do. That is one of the things that makes progress slow. People move around and change job and it can be difficult sometimes to ensure that the team that one is recruiting has the expertise and has been trained in the approaches that they need to use in order to be considered a specialist team.

What we see is that where the specialist teams have been and are being set up the people within those areas are seen quicker, assessed quicker, and treated and discharged quicker. Therefore, it works. That is what we know. Where we have them, it works really well. What we are seeing in the other areas is not that there is nothing but that there is not the full team in place. In an area where there is considered no specialist team there might be one person or two people on that team who have had that specialist training and when they get a referral of a person with an eating disorder, they will be the clinicians chosen within that team to deliver the treatment to that person.

In terms of whether there is enough training, within the clinical programme they need the training funding to ensure that as they recruit more teams that the people who come in can be trained in the specialist eating disorder approaches and just in knowledge about eating disorders. A big part of the work that I do is training. I am the training and development manager. Every year since I took on that role, there has been more and more training that I have been delivering to allied health professionals such as, in Mullingar General Hospital, the nurses, gastroenterologists and the dietitians who would not see people with eating disorders that often but who, when they do, need to feel that they know what they are doing. They need to know how to speak with that person. It is difficult working with a person with an eating disorder. There are many subtleties about it. What I am finding on the ground is that more and more people from many different areas that one might not think are coming forward and saying that they need more training in eating disorders because with Covid they are seeing people with eating disorders far more often. I suppose I am able to do that. It is part of my role. It is supporting the work of the HSE. Then, within the HSE, they need to know that their budget for training will be consistent so that they can ensure that the specialist teams in place are trained properly. Does that answer Deputy Hourigan's question?