36 years. Enough time to fall in love, have a kid, and climb the ranks of a workplace. But in the case of 49-year-old Mary Byrne, 36 years is the duration of time that she has struggled with anorexia.
At 13 years old, after experiencing severe trauma, Mary started restricting her food intake. Growing up in rural County Laois, Mary’s local doctor simply told her to eat more. Not understanding what was happening to her mind and body, she went off to the Institute of Technology, Carlow (Carlow IT), aged 18: sick, confused, and a total perfectionist, dead-set on graduating with a first class honours degree.
Despite her illness, Mary did just that. But in the four years she spent studying, she literally worked herself to the bone and no staff member or student seemed to notice. When she went to college doctors, she was told that her weight was normal and that she was “not sick enough” to warrant concern. After graduation, she was dropped into the real world with no support and was forced to deal with an Irish public healthcare system that did not have the resources to provide her with the interdisciplinary care she so desperately needed. “Going private”, for Mary, was simply not a financial possibility.
After nearly four decades of living with this debilitating condition, Mary has never received proper treatment. When she has tried to seek medical help, the psychological components of her anorexia have never been addressed. Instead, she has faced judgemental hospital staff fixated on raising her Body Mass Index (BMI), a standard measurement value based on the mass and height of a person. When she becomes “weight restored”, she is simply discharged and forgotten about, triggering relapse almost immediately.
Both college and public healthcare have failed Mary, who now believes that she will likely struggle with anorexia for the rest of her life. In her words, she has simply learned to “live with it.”
Looking back, she wishes there had been more support in place while she was at university. She believes that the college environment, which is filled with change, stress, and new experiences, ultimately exacerbated the disorder and left her unprepared for life post-graduation. The way she sees it, the State should be targeting this illness while people are still at university and young enough to focus on recovery.
While Mary grew up in a very different, more conservative Ireland in which mental health was treated as a conspiracy, her fight to find eating disorder treatment is one that transcends generations.
Trinity News has spent the last two months speaking with students, healthcare professionals, and government officials to get to the bottom of where the failure to provide adequate eating disorder treatment begins. What do colleges across the country offer their students? Should they be doing more? Or does the blame rest exclusively on the Irish Government?
College healthcare and counselling services are not standardised nationwide. The individual university decides how these services will operate based on the money it has available for it and the number of students it has to serve. Trinity has an embedded health service, meaning that there is a centre on campus which has its own doctors and nurses working for Trinity specifically. Together with University College Cork (UCC), it is one of two universities in the entire country with psychiatric care available. Other universities do not have their own medical team and instead hire a nurse on a contractual basis to help students a few times a week.
Most college health centres in Ireland are primary care providers that can refer students to specialists, but are otherwise only able to assist with more general, standard health concerns. While Trinity is unique in that it provides some secondary care services through Dr. Niamh Farelly, the College Psychiatrist who oversees a protocol for the Management of Eating Disorders (PMED), all college health services are limited in what help they can provide.
Speaking with Trinity News, Dr. Aoife O’Sullivan, the Irish College of General Practitioners (ICGP) clinical lead for mental health and UCC Student Health, explained the difference between college and public health services. “Universities obviously want to support student mental health but they’re not the HSE. They can’t replace a health service, they’re an educational service, to try and help their students as best they can … The university is not a healthcare provider, the university is an education provider.”
As a result, the comprehensive treatment required for students suffering from eating disorders cannot be provided exclusively by college services, because colleges are simply not financially equipped to do so.
This reality has left many students with eating disorders feeling like college health and counselling are more focused on the quantity of students they see, rather than the quality of treatment they provide. Current Trinity student Isabella* lost her father to anorexia a week before college started, triggering a spiral in her own disordered eating habits which started at 14 years old. When she turned to College health for help, she was extremely disappointed: “Initially when I went in, they kind of just dismissed it. The psychiatrist said, ‘but you’re a healthy weight so I don’t see what the issue is.’ … They didn’t really start taking me seriously until I said I had a family history of death by anorexia.”
Emmy, a 2012 graduate of Trinity, had an almost identical experience over a decade prior. After going to College Health for an injured foot, the GP immediately recognised that she was struggling with an eating disorder and referred her to St. Patrick’s Hospital – a private mental health facility – for treatment. Emmy found the treatment there to be hyper-focused on weight restoration above all else. When she returned to College having gained weight, the health centre staff just assumed she was “fixed”: “I remember kind of thinking, no one really cares about me anymore. Everyone thinks I’m fine, because I gained weight and I look fine.”
So if College Health and Irish hospitals – private and public – are more focused on the physical, where can students go if they need mental help? For most, the answer to this question is the Student Counselling service.
Trinity caps the number of counselling sessions students can have at eight a year. Once they reach this number, students may be referred to external, often lower-cost psychotherapy or residential options. While some smaller universities such as Carlow IT do not cap students’ sessions, according to Dr. O’Sullivan, this limit is fairly standard: “There’s a good lot of evidence for the big numbers of patients, which are anxiety, depression, stress, that the six to eight model of cognitive behaviour therapy (CBT) is a well established model, if you look at companies, like MyMind, or Silvercloud.”
“In terms of successful outcomes … someone with moderate to severe anorexia would need multidisciplinary care, so you’re talking 20 to 40 sessions of behavioural therapy by an eating disorder specialist”
However, eating disorders require a different calibre of psychological help: “In terms of successful outcomes … someone with moderate to severe anorexia would need multidisciplinary care, so you’re talking 20 to 40 sessions of behavioural therapy by an eating disorder specialist. Most universities can’t offer 20 to 40 individualised CBT [sessions] because if they did, counselling departments would be seeing 10 people with anorexia and zero other students,” O’Sullivan said.
“Unbeknownst to Rachel, the counsellor contacted her parents and told them that if her BMI was too low, she would be kicked out of Trinity”
Moreover, the experiences of those in eating disorder recovery who have attended Trinity student counselling are mixed. While Isabella, for example, had a positive experience, other interviewees found their counsellor – like Student Health – to be overly focused on the physical aspects of their condition. Current student Rachel* was paired with a counsellor after two months of waiting. From the get-go, the counsellor seemed to be more concerned about her BMI than anything else. Unbeknownst to Rachel, the counsellor contacted her parents and told them that if her BMI was too low, she would be kicked out of Trinity. This pushed her to stop attending counselling altogether: “I had to find other options for therapy because of the risk she was posing for me.” She described how her counsellor “didn’t prioritise me getting better and really only prioritised me getting kicked out.” Overall, this experience had a detrimental effect on her getting the therapy she needed.
When asked about the suspension of students from college due to low BMI, Trinity Student Counsellor Laura Fitzpatrick explained to Trinity News that this decision is ultimately made by the College Health team. She added that “it would be less a threatening of suspension but a duty of care and concern for a student who would continue and the negative implications it would have for their health … it’s taken from that compassionate framework, not as a threat.”
Reflecting on her recovery, current Trinity student Lucy*, who has struggled with an eating disorder since she was 15 years old, emphasised that if she had only started recovery in university, she never would have received the intensity and frequency of the private counselling which she required at the start through Trinity services: “When I just started recovery … I actually had to go to two different counsellors once each per week for about three months, and then I went to one for about a year. And now I’m going to one every two weeks. If I didn’t have a counsellor … I wouldn’t be here.”
What, then, is stopping Irish universities from increasing the amount and quality of counselling it can provide students? The answer is fairly obvious: money. So how much does Trinity allocate to student health and counselling services? The answer to this question is still largely unknown. The most recently published College financial statement in 2022 revealed that the College received a €57m grant from the national Department of Further and Higher Education, Research, Innovation and Science (HEA) but didn’t explain how much of this was apportioned to student health and counselling services. When Trinity News contacted Trinity’s Financial Services Division via email to discern how much the College received for this current academic year, where it went, and how the €279,000 it received from the HEA specifically for mental health services in December 2023 was used, the Division said it could not “provide the detail on the 2023/24 budget allocation for Health and Counselling services or how the monies received from the HEA in December were used.” Trinity News has yet to receive a comprehensive breakdown of where the grant money was allocated from any College department.
Assuming that the number of student counsellors and doctors being hired in universities does not change drastically in the next few years, the only option for most outside of college health is national, public services. But these, as explained by Mary, Emmy, and Lucy, aren’t sufficient either.
On Saturday, March 2, a group of protestors gathered outside of the Department of Health to protest the inadequacy of the services available.
In October 2023, the organiser of the protest, Amy Hanley, founded a campaign called Mind Everybody which calls for increased funding to be allocated for eating disorder treatment in Ireland. Amy started Mind Everybody after her daughter was forced to wait for over a year to receive treatment at a public children’s hospital. When she was admitted, she stayed in hospital for eight months without any psychological treatment: “Everytime a doctor would come into the room they would ask ‘is there anything you need?’ and I would be like: ‘therapy,’” Amy said to Trinity News.
Since her daughter was reliant on an energy tube, no interdisciplinary, in-patient facility would admit her. She was simply “too sick” and, according to the facility, would need to begin eating orally before admission. Amy was stuck and her daughter was on the brink of death: “It was that total Catch-22 where she needed the mental health support to break her reliance on the feeding tube and to help her to be able to eat orally, but she didn’t have that.”
Furthermore, Amy explained that “the area where you live restricts your access to in-patient units.” Since her daughter had been in a children’s hospital outside the “catchment” – Dublin’s geographic boundaries for accident and emergency cover – of the in-patient facility, she was doubly ineligible.
Trying to discern what makes one “sick enough” to be admitted to these facilities is a challenge for many people. Maynooth University student Lauren Gaffney has struggled for over a decade with this and has found that very few professionals in the country actually understand eating disorders: “[After fifteen years] I still have problems. Doctors reject me because they say that you’re ‘too sick’ to see. They tell you to go to hospital because that’s the only treatment for you, which is a force feeding facility. GPs say they don’t understand what an eating disorder is, that they’ll only be able to help you if you have a cough or the flu or if you need a prescription. But in terms of anything else, no … So you don’t know where you go, you have no place in society, you don’t know who you are, it’s a mystery.”
“One mother at the protest, Barbara, explained that she was quoted €65,000 for a 12-week treatment at the National Eating Disorders Recovery Centre (NEDRC) for her daughter”
With college and public facilities overstretched and underfunded and with private facilities costing an extortionate amount of money — one mother at the protest, Barbara, explained that she was quoted €65,000 for a 12-week treatment at the National Eating Disorders Recovery Centre (NEDRC) for her daughter — it seems that receiving treatment for an eating disorder in Ireland is near impossible.
So, who is to blame? Most Trinity students interviewed emphasised that the actual College staff are simply doing what they can with what they have. The extent of the funding made available by the College is something which Trinity News hopes to determine in the coming months. Despite this unanswered question, one thing is clear: the Irish Government needs to allocate more funding to eating disorder treatment. This is a crisis and as Trinity Psychologist Dr. Farrelly explained to Trinity News: “Treatment should … be flexible and tailored to that person’s needs, rather than offering a ‘one size fits all’ approach.”
* Name anonymised for privacy.
