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Mental Health Services.

Dáil Éireann Debate, Tuesday - 21 June 2005

Tuesday, 21 June 2005

Questions (34)

Dan Neville


54 Mr. Neville asked the Tánaiste and Minister for Health and Children her plans and programmes for the provision of services for persons suffering from eating disorders; if her attention has been drawn to the fact that eating disorders are serious psychiatric illnesses, with a 20% mortality rate; and if she will make a statement on the matter. [21183/05]

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Oral answers (5 contributions) (Question to Minister for Health)

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.

I thank the Minister for his comprehensive reply. He dealt with many issues I had intended to raise. When will the report on the mental health services be produced?

Given that 400 people are admitted to hospital each year with eating disorders, does the Minister accept that there should be a specialised service in each regional health service area to deal with this rather than just the three beds in Dublin? The Minister said there are 80 deaths each year or 20% of the eating disorder patients admitted to hospital. That is a significant number of deaths.

Perhaps the Minister will deal with another matter that has concerned me for some time, which is the eating disorder of obesity and the connection or influence it might have on those who have an eating disorder as outlined by Bodywhys. I congratulate Bodywhys on its work. The messages from the obesity campaign, which are important and correct and which I do not seek to criticise, might have an effect on those who have a starvation disorder such as anorexia nervosa or bulimia. The message being conveyed to the people with those conditions is that eating too much is bad. Should the campaign not focus on having healthy eating habits and attitudes rather than on reducing the amount of food one eats? I am concerned there will be an increase in the number of eating disorders as we know them as a result of the message being conveyed about obesity, which is an important matter in itself. There should be balance in how this is dealt with.

With regard to the obesity campaign, my colleague, Deputy Seán Power, is doing a great deal of work in the area of health promotion and promoting positive and proper eating habits. Much of that work is done through the schools and that is only right. It is the best place to get the message across to children. If they get the message at that stage, they will have it for the rest of their lives.

It is a complex matter, as Deputy Neville is well aware, to convey the message of healthy eating while taking account of how that affects people with anorexia nervosa and other eating disorders. The people we are discussing obviously have psychological and psychiatric problems. I will discuss the matter with my colleague, Deputy Seán Power, to ensure that everything we do will encourage positive eating and not have the side effect of adding to the problems of the people mentioned. I understand the point made in this regard by the Deputy.

The Deputy also mentioned the possibility of having eating disorder beds in each of the four HSE areas. That is a good suggestion. It is not acceptable for young people in remote areas, or their parents or guardians, that they should have to travel long distances to get treatment. I will consider that suggestion. However, a sub-group of the expert group is considering this matter and I wish to be guided by that sub-group, as the Deputy would wish to be.