Public Pathway for Adults

Note: This pathway will be updated as the HSE National Clinical Programme for Eating Disorders is rolled out nationally. Some areas may not yet have eating disorder (ED) or day programmes teams in place.

Step 1 – Contact the GP

The GP is the place to start. The GP will screen you, assessing your clinical and medical needs. If the GP is not clinically concerned, they will offer reassurance and advice. If the GP is unsure as to whether you have an ED, they will consult with the local AMHS / Adult ED team and monitor things. They may examine you and take blood tests or an ECG. If the GP is clinically concerned, they will refer you to the local AMHS (Adult ED team if established) for a further assessment. If they are worried about your physical health, they may refer you to a hospital for medical care.

Step 2 – A) Adult Mental Health Service (AMHS)* Assessment or B) Adult ED team Assessment**

Eating disorder assessment involves a multidisciplinary assessment at a clinic. This includes a clinical interview (where a clinician will talk with you to get an idea of what your day to day thoughts and feelings are, disordered eating behaviours, and will try to assess what and how severe the areas of concern are), physical examination, investigations and questionnaires. This assessment can take up to 2 hours. The aim is to make the correct diagnosis of your needs and to identify other conditions or complications that may be similar or related, such as depression or other medical conditions.  The doctors on the team will review your blood results and liaise with your GP about your physical health. Your weight and height will be measured.

A) If the AMHS / ED team assessment concludes that you do not have an eating disorder, the team may discharge you back into the care of your GP (If there is no other condition that needs treating there).

B) If you are diagnosed as having an eating disorder, then the next referral step is dependent on the level of risk assessed by the team.A person diagnosed with a low / moderate risk will be treated within the outpatient service. (Note: If the person does not respond well to this treatment, they can then be referred for more specialist support). If the person responds well to this outpatient treatment plan, they will, when ready, be referred back into the care of their GP (step down), or if the person does not improve, they will be referred into the more intensive day programme (step up).

– A person diagnosed with higher risk may be referred specifically for a more specialised treatment or day/ inpatient care.

– If the Adult ED treatment team assessment diagnose an eating disorder, the person will be treated within the eating disorder outpatient team structure.

– The person moves up or down these steps depending on their clinical needs and how they are responding to treatment.

*AMHS – Adult Mental Health Service – this is the general mental health service for the locality, which is not an exclusive eating disorder treatment team. There are personnel within the AMHS team that have the expertise to make an assessment of an eating disorder, and where there is is low to moderate risk, treat the person within the team.

** Adult ED team – This is a specific team dedicated to the assessment and treatment of adults with eating disorders, where a moderate to high risk is diagnosed. This is an ED outpatient service for the locality. It will take some time to roll out the ED teams across the country, so for the moment there may not be a specific ED team in place in your locality, however, there will be specifically trained ED clinicians with the C/AMHS teams.