Tim O'Malley (Limerick East, Progressive Democrats)

Responsibility for the management and treatment of a person with an eating disorder rests with the individual patient's clinician. However, persons presenting with eating disorders are generally treated through the local psychiatric services. Outpatient psychiatric services are provided from a network of hospitals, health centres, day hospitals and day centres. Where inpatient treatment is deemed necessary, it is provided in the local psychiatric unit or hospital, beds being allocated on the basis of patient need at any particular time. A tertiary referral service for eating disorders is available to public patients in St. Vincent's Hospital, Elm Park, Dublin, where three inpatient beds are designated for this purpose.

An expert group on mental health policy is currently preparing a national policy framework for the further modernisation of the mental health services. The expert group has a number of sub-groups looking at specialist issues in mental health services, including eating disorders. The expert group is expected to report later this year.

There are three main eating disorders — anorexia nervosa, bulimia nervosa and binge eating. In addition, there is another category of eating disorders not otherwise specified which has a high rate of psychiatric and general medical co-morbidity that often conceals, clinically and statistically, the underlying eating disorder or condition. There is little evidence that anorexia nervosa is increasing but there is a perception that cases are presenting at younger ages, sometimes as early as seven or eight years. It is estimated that there are 80 deaths per annum from eating disorders, that is, approximately 20% of the total number of eating disorders referred to the health services. It is also estimated that 60% of eating disorder patients recover while the remaining 20% partially recover.

There are three designated specialist beds for the treatment of eating disorders in the public psychiatric service. These are at St. Vincent's Hospital, Elm Park. There are also two eight bed units in the private sector, one in St. Patrick's Hospital and the other in St. John of God Hospital, Stillorgan. Due to the denial aspect of an eating disorder, it has been difficult to orient patients towards early treatment. It is not unusual to encounter first presentations in the accident and emergency department due to some other medical condition. The issue of early detection, therefore, is important.

There is strong evidence that general practitioners here are ill equipped to deal with eating disorders because of a lack of education in the area. Due to the complexity of eating disorders, inputs are required from many different professional skills delivered by medical, psychological, social work, nursing and dietetic personnel. These can only be provided through full multi-disciplinary teamwork.

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