The lack of public in-patient services for those suffering from anorexia is the subject of a judicial review this week, writes Fionola Meredith.

IT'S A brutal, life-threatening illness, moving with silent speed among a generation of teenage girls who have grown up in a body-conscious culture, bombarded with images of super-skinny women. It is estimated that 7,000 adolescents in the State are affected by Anorexia Nervosa. A recent survey, Eating Problems In Children and Adolescents (Epica), and carried out by St John of God's Lucena Foundation in Rathgar, Dublin, found that up to 11 per cent of teenage girls have "significant eating concerns".

Research shows that girls are now being diagnosed with the condition as young as six, and that suicide risk among girls with anorexia is 200 times higher than in the general population.

Anorexia is not solely a female problem. Psychologists are seeing more and more boys coming in for treatment. The situation is deteriorating so badly that one campaigner, Suzanne Horgan, of the Eating Disorder Resource Centre of Ireland, has described Anorexia Nervosa as "the next cancer" in Ireland.

And yet - extraordinarily - there are no designated public services in Ireland, north and south, for the specific management of eating disorders in children and teenagers.

On Friday a judicial review will be heard into the case of a 16-year-old girl suffering from anorexia who won the right to challenge the lack of specialist in-patient medical facilities available to treat her in Northern Ireland. The girl's legal team claims the current arrangements breach her rights to life, family life and freedom from discrimination under the European Convention on Human Rights. Justice Weatherup granted leave to apply for the review in October in the High Court in Belfast.

A small number of private beds are provided at St John of God Hospital and at St Patrick's Hospital, both in Dublin. Dr John Griffin, clinical director of the eating disorder programme at St Patrick's - which treats children aged over 14 - says the eating disorders sector is "grossly under-funded and grossly under-recognised: it is the Cinderella of psychiatry".

So that's why many parents are forced to seek treatment for their seriously ill children in Britain or further afield. This means a distressing separation from their families at a time when they are at their most vulnerable and in need of support; the fact that effective family therapy plays a big part in the recommended treatment of anorexia - and the likelihood of a sustained recovery - makes the problem even worse. What's more, making the transition from in-patient to out-patient care is the point where sufferers are most likely to relapse: that process is made all the more precarious when a child is having to cross jurisdictions.

Jacinta Hastings, chief executive of Bodywhys, the Eating Disorders Association of Ireland, says that immediate funding must be provided for dedicated eating disorder services for young people. "Given that the average age of onset for an eating disorder varies from 14 for anorexia to 17 for bulimia, the lack of child and adolescent services results in many young people going untreated and many others remaining undiagnosed or being admitted to facilities where there is no specialist eating disorder medical care."

There is a similar paucity of public care in the North. As in the Republic, a stream of seriously-ill youngsters with critically low body weight end up being "exported" to well-resourced British clinics, where the staff-patient ratio is often three to one.

At present, the teenager at the centre of the Northern Ireland judicial review case, who cannot be named, is being treated in a London hospital, where three other girls with eating disorders from the Republic are also receiving care. Her mother, Janine travels to visit her once a week, juggling support for her daughter with the need to maintain the routines and demands of daily life for the rest of the family.

Not surprisingly, this distressing and emotionally gruelling situation is taking its toll on the whole family, including the girl's siblings. Work commitments, schooling and extra-curricular activities must all be fitted in around the weekly trip.

"I want to make it clear that my daughter is not a victim, she's a victim of circumstance," says Janine. "It's heartbreaking when you see someone who has demonstrated so much strength being beaten and haunted by a disease that if it had been addressed earlier, and using guidelines that specialists in our own jurisdiction regard as baseline, might not have reached this stage."

What keeps her going through this terribly challenging time? "I take a lot of strength when I hear my daughter engage with her siblings - when I see that spark of laughter in her it means more to me than a whole evening full of laughs."

The Northern Ireland health authorities are reluctant to reveal exactly how much they are spending on sending children with eating disorders to England for specialist care, but at the recent court hearing barrister Tony McGleenan put the figure at more than £1 million (€1.2) a year.

Meanwhile, John Griffin, from St Patrick's, says he has been approached by consultants from the North about the possibility of sending youngsters to his unit, on the grounds that it's easier for Northern families to make the trip to Dublin than flying back and forth to London.

Experts agree that speedy intervention is key when it comes to treating eating disorders, especially in children and adolescents. Jacinta Hastings, of Bodywhys, says, "Early identification and treatment of emerging disorders have been shown to be effective, reducing the need for inpatient treatment and associated with better outcomes and subsequent cost reductions for the health care system". John Griffin says prevention is key, "educating 10- to 12-year-olds, rather than picking up the pieces at age 17 to 18".

The need for greater public awareness of eating disorders, as well as health promotion initiatives that support better understanding and awareness, was one of the key recommendations of the Government's 2006 policy document Vision for Change. But as far as Anne McCann, of the Eating Disorders Association of Northern Ireland is concerned, there is not sufficient awareness of adolescent eating disorders in the medical professions themselves. "Some GPs are not picking up on the seriousness and the urgency of this, telling parents that it's just a phase their daughters are going through."

Zara , from Belfast, now 25 and recovered from her illness, has had first-hand experience of receiving care as an in-patient in an adolescent unit at a London hospital. She was diagnosed with anorexia when she was aged 16.

"You spend your whole time wanting to come home, you get horrendously homesick. My parents would be flown over for family therapy once a month, but mostly I was relying on phonecalls." she saiad.

"I can't say for sure that if I had had a bed back at home my recovery would have been quicker - so much depends on timing, whether you are ready to get better - but the treatment itself is so hard, and being separated from your family just compounds that."

Feminist activist Ailbhe Smyth is a former anorexia sufferer. "I'm both angry and very sad that there are no dedicated public services here for girls suffering from anorexia. It's unbelievable that in 2008 Ireland still has no specialist treatment centre. It's not as if it's a new problem: we've known how serious eating disorders are for many years. I consider myself very lucky indeed to have survived."

Anorexia - and other eating disorders - have been likened to "screaming with your mouth closed". Until that silent plea is heard and translated into dedicated public support for young people with eating disorders, the suffering will continue.

• www.bodywhys.ie