Anorexia sufferer could be fed against her wishes, court told

A young woman with severe anorexia nervosa is to remain the subject of court orders allowing her to be fed against her wishes if necessary pending her expected move next week from an acute general hospital to a psychiatric facility, the High Court has heard.

The woman, a student aged in her 20s, now weighs just over 30kg, having had a dangerously low weight of 24kg, but concerns remain about both her physical and particularly her mental health. She has been involuntarily detained in hospital since April under the provisions of the Mental Treatment Acts.

Today, Simon Mills BL, for the woman, said doctors who recently independently assessed her believe the best option for her would be a co-located facility with access both to eating disorder specialists and acute hospital services, should her condition deteriorate.

A consultant psychiatrist who is part of a multidisciplinary team treating the woman said there is "a clear dearth" of specialist eating disorder facilities here. There is currently no specialist eating disorders unit co-located with an acute general hospital, he told the president of the High Court, Mr Justice Nicholas Kearns.

The doctor said the woman is expected to achieve a Body Mass Index (BMI) of 13 next week and, if she did, arrangements had been made to transfer her to a psychiatric facility. Her weight gain was slow, she had experienced physical difficulties when it was sought to reintroduce her to actual food and feeding via nutritional supplements had to be returned to, he added.

When Tim O'Leary SC, for the HSE, asked about her parents' hope that she could remain in the acute hospital until she achieved a BMI of 14/15, the doctor said a significant mental health problem is involved.

In the context of a busy acute hospital where staff were under many pressures, it would be a challenge to maintain the level of care she had been afforded to date, now she was out of immediate danger, he said. She has a psychiatric condition requiring ongoing care and needs to develop trust, he said.

Her father said “trust” is a big issue for his daughter and added he and his wife wanted to thank the doctors and multidisciplinary team for their care.

On consent of all the parties, the judge made an order keeping the feeding order in place for another week as a “medical safety net” while her expected transfer to a psychiatric service takes place. The treating team considered the order an important part of the overall plan for the woman, her doctor said.

Since the feeding orders were made in May, the woman agreed to co-operate with a feeding regime deemed necessary to safeguard her life and health, and no force feeding has been necessary.

The judge congratulated the woman for the progress she had made and thanked her treating team and parents for their treatment and care.

The court previously heard the woman has suffered with eating disorders since she was aged 12. She was detained involuntarily in hospital last April after doctors certified she had not the necessary mental capacity to appreciate the severity of her condition and her life and/or health was at risk unless she took the necessary levels of nutrition.

The court orders permit doctors, if necessary, to feed her by means including via a naso-gastric tube inserted after sedation. After the orders were made, she agreed to take nutritional supplements.