Martin Daly: Gaps leave youths without adult eating-disorder care
Martin Daly spoke on 21 January 2026 about failures in the transition of adolescents with eating disorders and neurodivergence into adult services, arguing the system leaves young people without care and lacks urgency. He criticised referral refusals, catchment-based 'Cinderella' services and the absence of clear pathways for ARFID and comorbid cases.
Transition gaps and handover failures
He warned the move from adolescence to adulthood is leaving many young people without service, particularly 18-year-olds who reach adulthood with no adult eating-disorder provision. Daly highlighted groups most affected - people with anorexia, ARFID, autism and other disabilities - and said the lack of handover and planning produces dangerous gaps.
Referral refusals and CAMS assessments
Daly criticised policies that allow some services to turn down GP referrals without assessment, pointing to CAMS as the only service described that does this. He and other speakers described a pattern where one service passes a patient to another with each saying 'that's not for us', leaving people without care.
Training, models of care and proposed fixes
A witness, Ms Parsons, said a clinical programme has run training that involved about 300 clinicians to build capacity, and argued a hub-and-spoke model should work in a small country. Daly and contributors called for a specific ARFID pathway in the new model of care, the creation of generalist hospital posts, a register of chronic patients and clear admission pathways when medical care is required.
Clinical consequences and lack of expertise
Daly cited a chronic anorexia case — a 36-year-old woman — noting an estimated 20% mortality from medical complications and suicide, to underline the stakes. He also warned that clinicians in general hospitals often lack eating-disorder experience, with parents reporting psychiatrists and other clinicians admitting they have no such experience.
Call for urgency and system reform
Daly repeatedly asked whether there is any sense of urgency from the health service and concluded that none was evident in practice. He criticised catchment-area governance as serving the system rather than patients and pressed for immediate action to close the gaps in transition, comorbidity management and access.
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A question was asked, and thank you firstly for coming here today, and again I was listening to Morning Ireland as well, and my condolences. The big issues here, this transition from, notwithstanding there's a plan, notwithstanding that things have improved, but they are nowhere near where they should be. Is there any sense of urgency about this? That's my first question. I might ask the questions and then allow you to respond to the urgency about this. This transition from adolescence to adulthood, we are seeing this really, I think Deputy Clark asked this question, we're seeing this really in one subset of medicine. We're seeing it in people who have mental health illnesses, you're speaking about anorexia, and also children who have other disabilities. This lack of handover, this lack of planning, and leaving this gap, most especially a gap in this service where there is no service in the adult service. So you have an 18-year-old who is going out to no service. The other issue is this comorbidities, the ability of services to turn down referrals from GPs. Again, we had been talking about CAMS recently. You know, these are the only services where a GP's referral is turned down without assessment. I mean, it's just, it's not, I can't comprehend it. It's the only service, and as Deputy, or as Senator Clonan pointed out, you know, for chronic sufferers of living with anorexia nervosa, the 36-year-old woman you spoke about, the mortality rate is in the order of 20% from medical complications and suicide. And then, finally, again, the Cinderella services of our health services are always governed by catchment areas. I just don't understand it. It's not about the system serving the patient, it's the system serving the system. So, I suppose, there are the questions, the transition, the comorbidities, the catchment areas, and the sense of urgency. Perhaps, you'll be able to go to counter that. Ms Parsons, if I allow you in, first place. I mean, I think in terms of the sense of urgency, absolutely. And what we know from the, like in the last year within the clinical programme, they'll be able to speak to it better than I, in terms of educating the wider health service, so that there, you know, if there isn't a specialist team, that there are at least clinicians within the general teams that are trained. You know, they've put together a training that had 300 clinicians at it last year to provide and to fill that gap. And I suppose Ireland is a small enough country, you would think that that's why the hub and spoke model works, you know, quite well. In terms of people falling between services, yes, that is a huge issue, and we hear about that all the time. Especially in relation to ARFID, and in relation to people who have a diagnosis of autism, that, yes, the GP will refer, and then the service will not accept that and say, well, that's not for us, that's for this service. And then that service says, well, that's not for us, that's an eating disorder. And we hear of that a lot. And I think there's been a huge increase in ARFID referrals, and there's no clear pathway yet, so that's something that needs to be put in the new model of care, to have a specific pathway for that, so that people who have that co-occurring neurodivergence that is, you know, causing difficulty in relation to the eating disorder can be treated in the appropriate service. I suppose the reflection is that there would be a generalist. We know who these people are, not just people with anorexia, but also other chronic illnesses who require readmission, readmission. Why we don't have a generalist position in a hospital with a register of these people who have cleared clinical pathways for admission when they need it. But I just, it's beyond my comprehension. I'm sorry you didn't get a chance to come in, the time has run out. Just briefly, if you just might reply briefly. Just in relation to the sense of urgency, there's no sense of urgency that we would see from the HSE in relation to trying to treat people. You also have situations that when people are gone into general hospitals where they're medically unwell, the clinicians in those hospitals have no experience of eating disorders. And I'm talking about psychiatrists treating somebody. And parents have asked, have you any experience of eating disorders? And the answer is no. Thank you.
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