Involuntary treatment of anorexia nervosa in Ireland: Challenges and changes in the legal framework

Anorexia Nervosa is an eating disorder typified by low body weight, restrictive eating behaviours, and body image distortion. It is associated with significant risk of medical complications, with one of the highest mortality rates of any mental illness. While the majority of patients receive treatment on a voluntary basis, a small proportion of severely ill patients refuse treatment and are treated involuntarily. The legal mechanisms used for involuntary treatment vary between jurisdictions, including mental health law, capacity-based law, guardianship, and use of inherent jurisdiction, the power of a superior court to rule on matters not included in statute. In Ireland, involuntary treatment of anorexia nervosa occurs within a legislative lacuna, not regulated by either the Mental Health Act 2001, or the Assisted Decision Making (Capacity) Act, 2015. Instead, treatment occurs under the Inherent Jurisdiction of the High Court, resulting in reliance on judicial discretion for decision-making. In this article, we explore the gaps in Ireland's current legal framework as applicable to care and treatment of anorexia nervosa, with reference to case law in England and Wales as a comparison. This includes an examination of the potential impact of the proposed changes to legislation as set out in the Mental Health Bill, 2024. We argue that these gaps mean that legislation governing the involuntary treatment of anorexia nervosa is urgently needed to safeguard the rights of this potentially vulnerable patient cohort, and ensure justice, transparency and consistency in legal approach.