Wednesday, 14 September 2011
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.
Before I read a reply on behalf of the Minister of State, Deputy Kathleen Lynch, who cannot be here, I would like to say I am delighted that this issue has been raised by Senator Power. I sincerely hope she does not let it drop. I am aware of the work being done by Ms Teresa Moorhead at the premises mentioned by the Senator. I appreciate that this is a massive issue in Ireland. I have been dealing with it through Ms Joan Barry and her parent support group. I am familiar with girls and young men who have had this problem. Along with my friends, I was able to support such people on a small scale in my former life.
Senator Power was right to say this massive and serious issue is not being dealt with properly. It was raised at our conference last week. I have discussed it with the Minister of State and her predecessor over the past two years. As we prepared to go into government, I worked with the previous Minister of State on this issue. I have no problem with saying the manner in which we treat this issue is totally outdated - it is 100 years behind the times. I expect that the statement I am about to read will not satisfy Senator Power. It sets out where we are today. I know from what the senior Minister, Deputy Fitzgerald, said at last week's conference that we will be tackling it.
I appreciate what the Senator said about the Lois Bridges centre, which is a short-term place. The way forward does not involve putting young girls into psychiatric units like St. Patrick's University Hospital. We need to use outpatient facilities and treat people in hospitals for short periods of time. I know several girls who have gone through Marino and into Lois Bridges. They have come out and gone on to get qualifications. The earlier the intervention takes place, the better. I know of cases involving girls as young as nine, ten, 12 or 13. There is no parish in Ireland that does not have a person with an eating disorder. Deaths have taken place. I have dealt with a family in which one girl has already died and a second girl is in trouble. This issue has to be dealt with and it will be dealt with by people like the Minister of State and Deputy Neville.
I cannot say too much about the funding because I do not have the finer details. We cannot afford to wait before we provide assistance to centres like Lois Bridges. I know Ms Teresa Moorhead is away this week. We told her we would have good news of some shape for her. I am pleased that this matter has been raised by Senator Power today. She should take it from here and not let it go. I have spent years working on these services to get them to where they are today. It is ironic that this matter was handed to me this evening. I assure Senator Power that I will work with her day and night. She knows what it is like for the girls who are dealing with this problem.
I am pleased to be here today and to have an opportunity to speak about eating disorders. The national mental health policy document, A Vision for Change, sets out the framework for the development of mental health services generally. The HSE's services for people with eating disorders are embedded in community mental health teams and primary care. The HSE, with Dublin City University, has developed a mental health in primary care accredited training programme for primary care practitioners. The skills included in this programme are designed to enhance the capacity of primary care to recognise, assess and treat a range of mental illnesses within the primary care setting. As individuals with eating disorders frequently present themselves to primary care practitioners with complications of their condition, early intervention at this level greatly improves outcomes.
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. If 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. Following the recommendation of the consultant psychiatrist, the HSE can and has worked with service providers in the independent sector. I know that has happened in some cases, but it does not happen often enough. The HSE and the independent providers have made specialised care available on an inpatient or outpatient basis. The Senator is familiar with centres like that in Marino.
In a limited number of cases, referrals to specialised eating disorder services in Dublin or the UK can be clinically recommended, and supported in appropriate circumstances, subject to the necessary resources being available. In a case in which a person was at death's door, the former Minister, Mary Harney, provided funding for that person to go to the UK. I would like to remember her on that note. HSE child and adolescent acute inpatient units provide evidence-based treatment to young people who require a period of admission by providing multidisciplinary care with dietetic input. Liaison child and adolescent mental health services in paediatric hospitals provide a specialist input during the young person's admission and co-ordinate a treatment programme that may involve admission to a child and adolescent inpatient unit, or interventions provided by the community child and adolescent mental health services.
The HSE also provides funding to Bodywhys, which is the main voluntary organisation that offers services to people with eating disorders. Bodywhys provides a range of supports to health promotion departments throughout the HSE. This interface provides welcome expertise from the user perspective. The situation with regard to services that are covered by private health insurance is that each private health insurance provider in the Irish market has the right to determine which health care providers they will cover for the benefit of their customers. Health insurers operating in a commercial market must choose the providers they cover. It is a matter for each insurer to determine how much capacity in any particular area is purchased by it to deliver the services required by its members.
I assure Senator Power that despite the economic downturn, she and this House can be assured of the Government's ongoing commitment to the development of mental health services in line with A Vision for Change. I reiterate the thanks I have expressed to the Senator for raising this issue, which is on the Government's agenda and is being dealt with by many people in various Departments. The Senator and I are aware that centres like Lois Bridges could be closed by Christmas. I have no problem saying that such a move would be a death sentence. I do not care who argues with me. The manner in which we are treating this problem at the moment is totally unacceptable, is not the way forward and has to change.
I thank the Minister of State for his genuine and honest comments and for the work he has been doing on this issue. Ms Teresa Moorhead told me that the Minister of State has been supporting this facility for a long time. I hope he can convince his colleagues that it needs assistance. Ms Moorhead has told me that it could be closed by Christmas. I hope he can convince his colleagues to back him up. I thank him for putting aside the script for a minute and speaking from the heart. I appreciate that.