Dáil debates

Thursday, 3 May 2012

Topical Issue Debate

Eating Disorders

3:00 pm

Photo of Tommy BroughanTommy Broughan (Dublin North East, Labour)
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I thank my Fingal colleague, the Minister for Health, for coming to the House to discuss this matter.

First, there are only three public beds, instead of the recommended 24, for eating disorders nationwide. Second, we do not have standards or regulations for physiotherapists and counsellors who work in this field.

In 2006, the Vision for Change report on mental health policy estimated that up to 200,000 people in Ireland may be affected by an eating disorder, whether anorexia nervosa, bulimia, binge eating disorder or otherwise. It also reported that approximately 400 new cases of eating disorder are diagnosed each year in Ireland which, shockingly, represents approximately 80 deaths per year.

A Government study of children and adolescents carried out in 2006 indicated that 1.2% of Irish girls are at risk of developing anorexia nervosa and 2% are at risk of developing bulimia. Figures from the Health Research Board report on the activities of Irish psychiatric units in hospitals indicate that eating disorders represented the second highest level of diagnosis, at 18%, of child and adolescent psychiatric admissions in 2008. There are also worrying trends internationally. A study of Scottish secondary school students reported that approximately a quarter of boys and girls had engaged in bulimic or anorexic behaviour.

Eating disorders, as a psychiatric condition, have a significant mortality rate. A 1995 study in the American Journal of Psychiatry, shockingly, found that "aggregate annual mortality rates associated with anorexia are more than 12 times higher than the annual death rate due to all causes for females aged between 15 and 24 and more than 200 times higher than the suicide rate of females in the general population".

This issue that does not predominantly affect girls and women, as the incidence of men who are affected by eating disorders is significantly on the rise. International studies estimate that as many as 25% of patients being treated for anorexia and bulimia are male and perhaps 50% of binge eating disorder cases are men.

All of these astonishing statistics have been compiled and highlighted by the outstanding campaigning organisation for victims of eating disorders, BodyWhys, led by Ms Jacinta Hastings. Many colleagues in the House, attended the excellent briefings provided by Ms Hastings during Eating Disorders Awareness Week in February and her follow-up briefings.

One of the most incredible facts surrounding eating disorders services is that there are only three beds in the public health system specifically designated for citizens with an eating disorder. Many patients approach their GP, and the Minister has emphasised that the treatment of eating disorders by community mental health teams is the best way forward. Bodywhys and other health professionals, however, believe there is an urgent need for at least 24 beds in the public health system to adequately treat the needs of the growing number of citizens with an eating disorder.

Recommendation 15.4.7 of A Vision for Change proposes an eating disorder sub-unit in a regional general hospital mental health unit with six beds each, which would contribute 24 public eating disorder beds. What can the Minister promise or what can he indicate will happen in this area? There is also a clear issue of equality at stake. With just three public beds, is it the case that only citizens who can afford private treatment will be able to access treatment for an eating disorder? There are many outstanding eating disorder counsellors and psychotherapists working in this country but it is an unregulated sector. As Bodywhys emphasises, citizens seeking treatment for an eating disorder are in an exceptionally vulnerable position. It is therefore essential that the areas of counselling and psychotherapy are strictly regulated to the highest standards. There is an opportunity for regulation, either by statutory instrument or by the introduction of legislation to the House. I urge the Minister to introduce regulations urgently in this regard and to ensure standards for counsellors and psychotherapists are provided either through legislation or by a statutory instrument. I seek a commitment from the Minister that eating disorder services will be introduced as a matter of urgency, as outlined in A Vision for Change, given the dramatic effect of eating disorders on young people.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank Deputy Broughan for raising this important matter for discussion today. I am responding to this topical issue on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who has responsibility for mental health issues. Health Service Executive, HSE, services for people with eating disorders are embedded in the main in the community mental health service and primary care. Individuals with eating disorders frequently present to the primary care practitioner with complications of their condition and early intervention at this level greatly improves outcomes. The HSE has developed a mental health in primary care accredited training programme with Dublin City University for primary care practitioners, with a view to enhancing the capacity of primary care to recognise, assess and treat a range of mental illnesses, including eating disorders, within the primary care setting.

Community based adult mental health services receive referrals from primary care and provide assessment and treatment to individuals with eating disorders. Child and adolescent mental health teams provide a similar role for their cohort of referrals. Where the individual's psychiatric or medical needs are more acute, inpatient admission is offered within the local psychiatric services or acute medical care where necessary. The HSE can and has worked with service providers in the independent sector to provide specialised care, on an inpatient and-or an outpatient basis.

Services for persons with eating orders are also provided in the voluntary sector and in this regard I should mention that the HSE provides funding to BodyWhys, the national voluntary organisation supporting those with eating disorders. Bodywhys provides a range of support services for people affected by eating disorders, including specific services for families and friends. As the House will be aware, a special allocation of €35 million was provided in budget 2012 for mental health. The funding will be used primarily to strengthen community mental health teams in both adult and children's mental health services, by ensuring, at a minimum, that at least one of each mental health professional discipline is represented on every team. More than 400 additional staff will be recruited to support initiatives under the €35 million package. It is intended that the additional resources will be rolled out in conjunction with a scheme of appropriate clinical care programmes. Three areas in particular will be prioritised in 2012, one of which will be around the treatment and care of patients with eating disorders. These programmes are currently being finalised.

On the regulation of psychotherapists and counsellors, the priority of the Department of Health for the foreseeable future is the statutory registration of the conventional therapies, through the full establishment of the Health and Social Care Professionals Council. Before statutory registration can be considered for other therapies, such as counselling and psychotherapy, there is a need for each individual therapy to federate so that it can advise, as a single voice, on professional standards. That was a recommendation of the report of the national working group on the regulation of complementary therapists. The Higher Education and Training Awards Council is currently working with representatives of the professional bodies and higher education institutions that provide courses in counselling and psychotherapy, along with international experts, to determine national standards of knowledge, skill and competence to be required for the award of higher education qualifications in these fields. While academic qualifications are not sufficient in themselves as a means of professional regulation, agreement on academic standards does form a critical building block for any modern regulatory system for professions. I trust this clarifies the issues for the Deputy.

Photo of Tommy BroughanTommy Broughan (Dublin North East, Labour)
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I thank the Minister for attending and for his reply. We all welcome the allocation of the €35 million secured through the budget by our colleague, the Minister of State, Deputy Kathleen Lynch, for mental health services. The question is, however, whether it will lead to more acute beds in front line services. That is one of the main points of today's debate.

I have liaised with the Minister for Children and Youth Affairs, Deputy Frances Fitzgerald, on the problem with psychiatric services for 16 year olds and 17 year olds. I am sure the Minister is aware of the issue. I welcome the point made by the Minister on the certification of psychotherapists and counsellors. As outlined by him on the second page of his reply, however, it appears to be a lengthy process. Is there some way the Minister could take decisive legislative action either by administrative means or otherwise to ensure the process is accelerated?

An issue of fairness arises in terms of the current provision. The Minister mentioned that some independent providers have been licensed to offer services but the fact remains that families on lower incomes will not be able to access them. There is still a clear requirement for additional beds.

Education is a major issue, both for the Department of Health and the Department of Education and Skills in terms of self-perception and people being accepting of different body types. I recently heard the Minister speak forcefully about smoking. He made a strong case on health grounds. I commend him on his interest in this major issue. Perhaps this is another area in which the Department could put its shoulder to the wheel in terms of education.

Deputy Mary Mitchell O'Connor raised the issue of websites which seem to promote anorexia and bulimia. I am concerned about the action that should be taken in this regard. I note the French Government has taken decisive action - the government there might change on Sunday to the benefit of all of us in this House. Does the Minister propose to take action against people who are causing harm? I accept he did respond previously to Deputy Mitchell O'Connor on the matter, as did the Minister of State, Deputy Kathleen Lynch.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank the Deputy opposite for his comments on the additional resources made available by the Government for mental health issues. It is an area to which the Government is very committed. The Taoiseach is also very interested in it. More work remains to be done in terms of having more organisation around specific beds for the treatment of eating disorders. Currently, as Deputy Broughan outlined, there are a number of designated beds but other beds are also used for the treatment of such conditions.

Like Deputy Broughan, the Minister for Children and Youth Affairs, Deputy Fitzgerald, and I are concerned about the changes that occurred vis-À-vis the law on the age of a child, which increased from 16 years to 18 years and the difficulties that created in terms of the provision of proper psychiatric and psychological services for children in that age group.

I am very concerned about regulation. The printed reply might have referred to the future but I am aware the change must be more urgent. There is a real need for GPs and community nurses in particular, and other professionals, to be confident they are referring individuals who need counselling, whether for an eating disorder or otherwise, to properly qualified and competent individuals. The regulation of counsellors and psychotherapists is very much on my agenda. As I outlined, we are currently organising issues around ancillary health professionals but I also want to address the issue of other therapists. I believe there is a real role for people in this area but there is a need to protect patients and ensure they are going, and the referring physician, nurse or clinician can have the confidence that he or she is referring, to a suitably qualified person.

I note the issue of education in this area. Certainly, that requires more co-operation between ourselves and the Department.

The other issue about websites and licensing is something I will discuss with the Minister of State, Deputy Kathleen Lynch, and we should raise that as well with the Ministers, Deputies Fitzgerald and Shatter, on a cross-departmental basis.

As Deputy Broughan pointed out, it is an area of real concern. It is a difficult area to treat for professionals. If intervention occurs early, the bulk of cases can be handled without admission to hospital, but there are occasions when that is required. Certainly, we will look into how we can better organise that facility in a more specialised way.