A Dublin woman, who has spent her last four birthdays in hospital battling severe anorexia, is appealing for specialist eating disorder services for all who need them, regardless of access to private health insurance.
Eating disorder presentations increased by 66 per cent in the past year, compared with 2019, of which 58 per cent were for anorexia nervosa.
Sorcha Dunne (20), who lives in Lucan with her mother, was diagnosed with the disorder in 2017 but believes she had it from about age 12. She was admitted to Tallaght Hospital in December 2017 with severe malnutrition and was tube-fed for three weeks before being transferred to Linn Dara, an in-patient mental health unit for children and adolescents, where she stayed until August 2018.
“I tried to do sixth year. I was going to [mental health services] every week but was just getting worse,” she said.
She was readmitted to Linn Dara in November 2018, but had to be discharged after turning 18 the following January.
“They didn’t want to discharge me in fairness, but there was nowhere for me to go because I don’t have health insurance.”
There are about 30 specialist eating disorder beds in the private sector but just three adult public beds, all in St Vincent’s Hospital in Dublin, and these are only available to its catchment area.
The treatment available to Ms Dunne was a weekly visit to a local primary care centre in Ballyfermot, where she saw a psychiatrist and was weighed.
She said her weight fell again that June and she ended up in Tallaght Hospital for 10 weeks, before getting a HSE-funded private bed in St John of God's eating-disorder unit in Stillorgan.
“I found it really helpful. I was doing a lot better.”
Following her discharge last March – just as lockdown started – Ms Dunne continued with the St John of God’s day programme for three months and did “okay”.
“But soon I went backwards, restricting my food and going out for big long walks.”
Ms Dunne was referred to a HSE dietician once a week. “She is really good… My weight was low but it was pretty stable. But I was afraid of putting on weight. I got worse and suddenly things got a lot worse very quickly.”
She was admitted to Tallaght again last December. After several weeks losing weight, she was put on bed-rest and supervised during meals. “I started gaining a little weight, got freaked out and discharged myself in February.”
She sees the dietician once a week, and less frequently a psychiatrist and social worker, in Ballyfermot.
Ms Dunne wants to recover, but the higher her weight gets the “further away I am from what feels safe”, she says.
“I know logically I cannot recover and stay underweight, but it’s scary not to be underweight. I’m just used to it. I get overwhelmed and panicked at the thought of being a normal weight.”
St Patrick’s psychiatric hospital in Dublin has eight specialist eating disorder beds and treated 76 patients last year. About 11 per cent were HSE referrals and 95 per cent were female.
Describing anorexia as "a very serious, complex disorder", its medical director Prof Paul Fearon says of all mental health conditions "it has one of the highest mortality rates due to the medical complications of severe malnutrition and the high rates of suicide".
At St Patrick’s, he says, in-patient treatment continues for several months and is followed by about 12 months of aftercare. Full recovery is not guaranteed.
“It absolutely must be treated with more than diet. There’s the cognitive angle, the behavioural and belief angle, any other concurrent psychiatric illness like depression or anxiety disorder. And involvement of family is key.”
Prof Fearon agrees there is a dearth of services.
“We all need to be looking at this. We know the incidence of most eating disorders is up. There is a need and clearly there aren’t enough beds,” he said, adding that St Patrick’s is examining increasing its capacity.
Ms Dunne says she is “lucky with the team in Ballyfermot” but feels unable to overcome her illness without specialist in-patient treatment.
“It’s just hard. There should be the beds for all the people who need them, not just for the people who have health insurance.”
A spokeswoman for the HSE said she could not comment on Ms Dunne’s case. A network of 16 specialist eating disorder teams was planned – eight child and adolescent, eight adult – to address “current unmet need”, she added.
There are two child and adolescent teams in Cork/Kerry and Dublin South, Kildare and west Wicklow, and an adult team in the HSE East region. Planning for the next three, serving Galway, Mayo and Roscommon (child and adolescent); Cork/Kerry (adult), and Dublin north (adult), begins this year.
Anyone concerned about an eating disorder should contact Bodywhys at bodywhys.ie, 01-2107906 or email email@example.com