The growing incidence of mental illness and the inadequacy of the resources allocated to the problem has been sharply highlighted over the last year of lockdown. In particular, the impact on young people has rapidly become a matter of national concern.
Justice Peter Kelly, recently retired President of the High Court, has spoken of the distressing experience of families who have had to resort to court injunction to find treatment for victims of anorexia, a disease which affects an increasing number of young females.
In particular, the judge – who dealt while on the bench with a large number of such cases – is highly critical of the deficiencies in mental-health legislation that require anorexic patients to be made wards of court before emergency treatment can be administered.
So concerned is the former judge at what he saw as the plight of anorexic sufferers that now, in his retirement, he has pledged his active support to Cared Ireland. This parent support group is campaigning for reform of current mental-health legislation to make it more effective and more relevant.
While Justice Kelly’s firsthand experience of dealing with anorexia cases has reaffirmed his view that sweeping legislative change is needed, his immediate concern is the question of patient refeeding, one of the required treatments for people with anorexia.
Ireland is the only common law country where it is mandatory that patients are made wards of court before refeeding can be administered. The rationale is that something so extreme should not be lightly embarked on – hence the rigorous insistence on court permission. However, Justice Kelly is of the firm view that court intervention is more a hindrance than a help.
Such treatments as involuntary feeding should, he argues, be considered a normal part of the management of anorexia. As such, it should be a medical decision taken without resort to court, a process that in itself leads to both delay and distress.
The paucity of resources to cater for the growing levels of eating disorders is measurable. There are only three eating-disorder beds for adults in the entire HSE system, with four in-patient units for adolescents. Those with health insurance can access eating-disorder beds in private psychiatric hospitals in Dublin, where the HSE, subject to resources, will also fund the treatment of a small number of public patients. In addition, the NHS in Britain also makes its facilities available to Irish patients – but only on a limited basis.
Patient advocates have long campaigned for the provision of special units with trained staff to deal with presentations of eating disorders. Emergency units of general hospitals, often the first point of reference for eating-disorder patients, are ill equipped to deal with what is recognised as an intractable condition.
In Justice Kelly’s first submission to the Department of Health, he emphasises that nursing and support staff need specific training in what is a specialist area. And until that is addressed, little progress seems possible.
Eating disorders are but one piece in a mosaic of challenges facing the Government in terms of mental health. By common consent, psychiatric care has become the poor relation of the entire health system, and is underpinned by legislation that is out of date and no longer fit for purpose. The broader issue of patient consent – incongruous when by definition a patient is unable to make a rational decision – is exemplified in Justice Kelly’s observation on the appropriateness of court interventions.
Judge Kelly’s decision to enter the debate, bolstered by his firsthand experience at the coalface, should go a long way in helping turn the tide in favour of reform and improvement.