Averil Power (Fianna Fail)

The statistics on eating disorders in Ireland are alarming. According to the mental health strategy, A Vision for Change, up to 200,000 people may be affected by eating disorders and an estimated 400 new cases emerge each year. There are, however, fewer than 20 beds available to treat patients with eating disorders between St. John of God Hospital, St. Patrick's Hospital and St. Vincent's Hospital. There are long waiting lists for these beds.

Apart from leading to major health problems such as cardiac dysfunction, osteoporosis and hypothermia, the mortality rate from eating disorders is high. According to A Vision for Change, 80 people die every year from eating disorders in this country. As the American Journal of Psychiatry has highlighted, the aggregate annual rate of mortality associated with anorexia is 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.

The programme for Government agreed by Fine Gael and the Labour Party states the Government is committed to reducing the stigma around mental illness, ensuring early and appropriate intervention and vastly improving access to modern mental health services in the community. The need for vastly improved services for people with mental health problems, including eating disorders, has been recognised by the Government. I was therefore genuinely surprised last week, upon visiting the Lois Bridges centre in Sutton and seeing its excellent facilities and the programme the clinic director, Teresa Moorhead, has put in place, to hear the HSE is not fully utilising the service and that none of the private health insurers have agreed to cover it.

Lois Bridges is the first non-hospital based dedicated residential care facility for people with eating disorders in Ireland. It opened in February 2010 and has six residential beds and offers care on a seven day a week basis, focusing on treating the reasons behind an eating disorder. The team includes practitioners in psychiatry, psychology, psychotherapy, medical professionals, nurses, social workers, family therapists and dieticians. It covers every angle of support a person needs. As well as residential facilities, it offers a comprehensive outpatient service and aftercare of up to a year for each individual.

It also focuses on supporting and educating a person's family, a service that hospitals often fail to cover. It is important because the patient who goes home needs a supportive environment where those who are important to the patient know how to help him or her, especially if he or she falls back.

Lois Bridges has been approved by the Mental Health Commission. It has been inspected three times so its status is the same as hospital-based facilities. By taking the holistic approach I have outlined, it not only treats the symptoms of the eating disorder - weight loss and associated health problems - it also treats the causes, particularly psychological and emotional causes. As the director explained, many people with eating disorders have had some major trauma in childhood such as sexual abuse, bullying or low self-esteem. Focusing simply on food and calorie counting diverts from dealing with the underlying problems and fails to address the long-term risk factors the patient will face at the next emotional upheaval.

The non-hospital based nature of the centre is crucial. Hospital-based services are important but as eminent experts in the area have pointed out, they also have serious deficiencies. Some of these were highlighted in an excellent article in The Irish Times in which Professor James Locke, the director of the Stanford child and adolescent eating disorder programme of California, pointed out that a person with an eating disorder will gain weight during inpatient care in hospital, which is the immediate medical priority, but once he returns to his home programme, the patient will lose most, if not all the weight he gained in hospital. He has found the patient will gain 20 pounds in hospital but the majority will lose two thirds of this within a few months of returning home. The cost of hospitalisation is enormous and the benefits can be marginal. Lois Bridges, however, can offer a comprehensive service for less than the hospital-based services offered in the Dublin hospitals.

When I was with the director last week, she went through a number of personal stories with me. She outlined the cases of people who are on long waiting lists for places in the hospital and have been told they will have to wait for months. If one had a physical injury like a broken leg, one would want to be in an accident and emergency department straight away. However, people with significant emotional and physical problems are being told they have to wait for months.

I do not understand why the HSE is not utilising this service fully. I appeal to the Minister of State, Deputy McEntee, to speak to the Minister for Health and urge him to ensure this service is availed of. The Government should use its influence with the health insurance providers to ensure they start to cover this service. It takes huge courage for people with mental health problems, including eating disorders, to put their hands up and ask for help. Some people have taken that step only to find that help is not available without being placed on a waiting list. They learned that places were available at an excellent facility in Sutton and made the necessary calls, only to be told that funds were not available. That is genuinely a scandal. I hope the Government will do its best to change it.