Two young women with severe anorexia nervosa who were made subject of court orders permitting them to be force fed through a tube if necessary have made progress, but issues of concern remain, the president of the High Court has heard.
The father of one of the women, hospitalised involuntarily since last April due to her weight dropping as dangerously low as 24kg, secured an order from Mr Justice Nicholas Kearns directing the HSE to have a detailed written aftercare treatment plan for implementation whenever she is discharged from hospital.
His daughter, who has suffered from eating disorders since aged 12, was previously discharged with no such plan and had “fallen through the cracks”, the father said.
A psychiatrist who assessed the woman at the request of lawyers representing her interests agreed with a HSE psychiatrist that she lacked the necessary mental capacity to appreciate the severity of her condition, John Lucey SC said.
A 15-page letter from the 26-year-old woman expressing her views about her treatment and other matters was handed in by Mr Lucey. On being told the woman would like to express her views herself but was physically unable to attend court, the judge said he would hear from her via video-link if that was regarded as appropriate.
The feeding orders made in the case of the second woman, dating from January last, were discharged today in circumstances including that her weight has now reached 39/40kg and she will be the subject of a detailed aftercare plan involving daily visits to hospital.
Orders permitting her detention under the Mental Treatment Act will also be lifted, the court heard.
That woman, aged 22, remains “terrified” of putting on weight but recognises she needs nutrition if she is not to die, her treating psychiatrist told the judge. She self-harmed on occasions to get back to hospital as she received a lot of attention there and addressing of such institutionalisation by having her discharged home and permitting her to return daily for therapy was being sought, the doctor added.
Both cases were before Mr Justice Kearns for review. Both women are students who were detained involuntarily in hospital under the provisions of the Mental Treatment Acts after doctors certified they did not have the necessary mental capacity to appreciate the severity of their condition and their lives and/or health were at risk if they did not take the necessary levels of nutrition.
Today, the judge was told, after he had made the orders sought by the HSE to permit force feeding of the women if necessary by means including via a naso-gastric tube inserted after sedation, both agreed to take the nutritional supplements.
In the most recent case, of the 26-year-old woman, Timothy O’Leary SC, for the HSE, said her condition is significantly better and she had gained some weight. Her doctors believed her agreement to take nutritional supplements was due to the court orders and it was “still early days”.
Her father had in a letter made a number of “historical” points about her treatment which could be addressed later if necessary, and he wanted a written concrete plan for her, counsel said.
The father told the judge it appeared his daughter would in two weeks’ time achieve a weight level where she would be discharged. She was previously released with no back-up plan except for one hour a week, and her parents wanted a detailed plan for her.
In the second case, Peter Finlay SC, for the HSE, said the woman, whose weight was 26kg at one point, had progressed from a position of near organ failure to reaching a weight of 39/40kg. This was a “success story with a small s” and she needed a planned aftercare programme on her discharge home.
Her psychiatrist said she was satisfied the woman now has mental capacity to appreciate her illness, having made significant physical and cognitive improvements after taking necessary nutrition.
The woman does not like her weight gain but is clear she does not want to die, the doctor said. There were concerns her weight could drop when she went home but measures had been put in place aimed at addressing this.
The woman’s lawyer said she was a bit anxious about the aftercare programme but thanked her doctors for their care. The judge said his concern was to ensure the woman was not stepping into “a void” on discharge from hospital and thanked the psychiatrist for her “excellent work”.
