# Residential clinics in Ireland for the Morbidly Obese?



## delgirl (17 Mar 2005)

Does anyone know of any clinics in Ireland that provide residential weight loss / counselling programmes for the morbidly obese?

I have a relative who is very depressed, smokes 60 cigarettes a day and is morbidly obese.  I feel the only way to help (many other approaches have been tried and failed) is to persuade this person to take part in a residential programme where medical doctors, psychiatrists, nutritionists and physical fitness experts are on hand to assist.

I've tried google and not turned up anything.  Maybe there aren't any clinics in Ireland?

Title expanded by ajapale


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## sluice44 (17 Mar 2005)

*Re: Morbidly Obese*

I'm not an expert....

Talk to your GP - they've seen/heard everything before.  I'd suggest treating the depression first, then they might be motivated to stop smoking and address their weight afterwards.

Also, under EU rules, if the facility you're looking for is not available in Ireland, one can go abroad for treatment and the health board (?) is obliged to pay for it.  Didn't Tommy Gorman of RTE make a programme on this issue when he had some sort of brain cancer?


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## ClubMan (17 Mar 2005)

*Re: Morbidly Obese*

*Talk to your GP - they've seen/heard everything before.*

I'd second that. If depression has been diagnosed then treating this will go hand in hand with dealing with other issues such as general physical health etc.

*Also, under EU rules, if the facility you're looking for is not available in Ireland, one can go abroad for treatment and the health board (?) is obliged to pay for it. Didn't Tommy Gorman of RTE make a programme on this issue when he had some sort of brain cancer?*

As far as I recall he availed of cover available under the _E112_ scheme and this, along with _E111_ and other schemes, has not been superceded by/subsumed into the ECIC scheme.


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## delgirl (17 Mar 2005)

*Re: Morbidly Obese*

Thanks for your responses.  This person has been treated for the past 20 years by a GP who, after trying various anti-depressants, seems to have given up.  His attitude at the moment is 'there's nothing more we can do for you until you want to help yourself'.  

Very easy to say when your not in the black hole that is depression and the vicious circle that makes exercise difficult because of the weight and lung damage.

Her partner has recently come into some money and feels that throwing some of it at the problem as a last resort might bring some normality to their lives.  Maybe residential care in a clinical environment might prove to be the catalyst which leads to some improvement.

Currently she is up most of the night watching TV and eating.  She sleeps until around 2pm and only gets up for a cup of coffee and goes back to bed again.

He's a nice person, maybe a bit too nice bordering on the 'enabling', who's at his wits end and I'm trying to come up with some suggestions / solutions which may be of some help.


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## ClubMan (17 Mar 2005)

*Re: Morbidly Obese*

*a GP who, after trying various anti-depressants, seems to have given up.*

If the _GP_ only recommended a course of medication without any form of talk therapy/counselling then I'd strongly recommend that the patient consider choosing another _GP_ who knows how to treat illnesses such as depression properly! If what you say is truly representative of the _GP's_ attitude then it is a complete disgrace and something that should not be tolerated. Can you say what sort of depressive illness was diagnosed and what medications were prescribed? Has any specific underlying reason for the depression been identified? Has any sort of talk therapy/counselling been attempted? Has the person ever sought support from other self-help, counselling, helpline services etc.? Did they ever find that one particular attempt at a solution showed more promise than others? I would caution against people expecting a "big bang" solution to all of the issues here (depression and related illnesses if applicable, obesity, smoking, insomina (?) etc.) in one go as this is unlikely to be a reasonable expectation.


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## Biggles (17 Mar 2005)

*Re: Morbidly Obese*

I recall seeing a programme on RTE some months back which revealed a frightening level of willingness among GPs to prescribe medication as the first option to deal with depression. 

I would agree that in the first instance, this person should seek (or a friend should seek) the advice of a good and interested GP.  

In my opinion, the faith that patients have in their GPs is undeserved in many cases.


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## ClubMan (17 Mar 2005)

*Re: Morbidly Obese*

To be fair, many _GPs_ these days are aware that (a) medication should only be prescribed where absolutely necessary and (b) that a two pronged (drug and therapy) approach to treating depression and related illnesses is generally the most appropriate strategy. 

As an aside.... in my opinion the concerns about most modern anti-depressant medications and treatments are rather overstated (e.g. that tabloid style _Panorama_ programme about _Seroxat_ a few years back, the regular rolling out of horror stories about _ECT_ which is still a useful therapy in some circumstances etc.) and much of the media coverage breeds ignorance (e.g. anti-depressants are addictive, change personality, always cause the side effects listed etc.) rather than enlightenment about mental illness and its potential drug and talk theraputic treatments which helps nobody, especially those affected directly or indirectly by such illnesses.


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## holly23 (17 Mar 2005)

*Re: Morbidly Obese*

Hi

Is she in Dublin ?

You could try the Marino Centre for eating disorders.

Its not residential but they do offer counselling for eating disorders, compulsive eating and 'eating distress', where food causes the person a problem.

They have a no diet approach and try to get to the root of the emotional component of the overeating.

Its a horrible place to be and it can be heartbreaking to live with someone in that space. At the root of the problem is usually very low self esteem, and a belief that life would be perfect if only the person was thin.
There are a number of good books out there...anything by Geena Roth is good, espically a workbook called 'why weight' which challanges the reader to confront why they eat and how they can overcome the eating problem.
You could also try www.bodywhys.ie
Best of luck

_Edited by ClubMan to fix link._


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## delgirl (18 Mar 2005)

*Re: Morbidly Obese*

Thanks again for the replies - Holly23, she actually lives in the North, that's why I'm looking for some sort of residential programme.

She's very difficult to help at this stage - particularly with the rock bottom self esteem and feelings of hopelessness.  Is currently very unapproachable and will not even answer the telephone if it's not her husband on the line - she has caller id and knows who's calling.

I've located a few private hospitals on the UK mainland who provide residential care and will try to suggest to her husband that one of these may be worth a try.  

I think at this stage she is incapable of making rational decisions for herself and it's up to him to take matters into his own hands and to seek the appropriate care for her.  Unfortunately, after over 20 years of dealing with her depression, anxiety etc. and walking on eggshells, he has become somewhat desensitized to her plight and cautious about rocking the boat.

I'll update if we manage to find some help - it may help someone else who's in the same situation.


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## Tonka (18 Mar 2005)

*Depression and Obesity are a lethal combination*

Now you mention 'husband '  I confess I  am surprised he never 'signed her in ' for a programme ?


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## car (18 Mar 2005)

*..*

I know you said youre in the north, but is there anything useful on the [broken link removed] website?  

check out their home page for a wide range of medical services and a chat room.


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## ClubMan (18 Mar 2005)

*Re: ..*

* Now you mention 'husband ' I confess I am surprised he never 'signed her in ' for a programme ? *

Not sure what you mean. Can you explain.

Is there any possibility that this individual might be in such a bad state that they may need to be sectioned/committed for a period of treatment for her own good and that of others around her? I just get the impression that the situation is pretty serious?


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## purple (18 Mar 2005)

*Re: ..*

She should ask her GP to refer her to a psychiatrist. Her GP is not a specialist and after that sort of time frame without results they should have sent her on to a consultant.
I agree with Biggles comments about too much faith being placed in some GP's.


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## Tonka (19 Mar 2005)

*yes Clubman*

"sectioned/committed for a period of treatment"

is what sign her in means. In other words I am afraid the poor womans health will not improve unless a responsible relative makes the decision for her.


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## ClubMan (19 Mar 2005)

*Re: yes Clubman*

Thanks _Tonka_ - I just wasn't sure what you meant by "signing in".


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## Sherib (19 Mar 2005)

*Re: Morbidly Obese*

This is what I would suggest:

(1)  See a *Consultant Physician* preferably an Endocrinologist.  There are many hormonal conditions that she could be suffering from.  At the very least these should be outruled.  In addition, gross obesity results in many health risks which may also be inpinging on your relative.

(2)  See a *Consultant Psychiatrist* for a full assessment.  There are many new drug treatments available now and a good Psychiatrist should be up to date with other adjuncts like psychotherapy.

She could be suffering from an obsessive compulsive disorder but I wouldn't prempt a specialist's diagnosis.

If you want to help your relative just remember that however well intentioned you may be, "help" is not always welcome. Sectioning a person is a very serious step and is usually reserved for the psychotic.  It doesn't sound as if she is psychotic but she does need help.  Since her condition is a long standing one, even if she has had these examinations years ago, it would still be sensible to be seen again assuming she is co-operative.  

These are simple steps to take and likely to be the least disruptive and most acceptable.   There is an excellent health service in Northern Ireland from what I hear.  Even if it means going privately, it would be money well spent and a lot less than private institutional care which may not be available anyway. She might even be admitted to hospital for her examinations.  Just make sure that the specialists are attached to the same hospital, preferably a University Hospital.  

I hope you are successful in getting the ball rolling.  She's lucky to have a relative who is concerned for her welfare.

8)


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## joanmul (19 Mar 2005)

*Re: Morbidly Obese*

I have a close relative who works in the St Francis Medical Centre in Ballinderry, Mullingar, Co Westmeath.   They run, as far as I know, a programme for treating clinically obese people.   A few years ago, under the VHI, people could go there for treatment and usually were in for 3 weeks to begin with.   I don't know how they continued the treatment after that.   Then the VHI pulled the plug because they decided people were availing of a 'holiday' - (in a private hospital)!   There are ways around this if you have private health insurance if you are being treated for 'something else' that necessitates in-patient treatment and can as a separate issue be treated for one of the 'causes' of the symptoms - i.e. obesity.   You need a sympathetic GP and if the one you have isn't find someone else.

As for Ballinderry, my husband was there for varicose vein removal and my daughter for an eye complaint and both had very satisfactory treatment.

Hope this helps or gets the imagination going on finding a solution.


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## ClubMan (19 Mar 2005)

*Re: Morbidly Obese*

*Sectioning a person is a very serious step and is usually reserved for the psychotic.*

Just to be clear, I was not recommending this as a course of action and in no position to recommend any course of action in this context (even less so than offering financial advice!). I was just throwing out ideas in a brainstorming fashion as food for thought and in the hope that there might be some useful suggestions in there.


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## Sherib (19 Mar 2005)

*Re: Morbidly Obese*

There seems to be some misunderstanding here - I didn't think you were _recommending_ anything.  In fact it wasn't you who wrote



> I confess I am surprised he never 'signed her in ' for a programme


I confess to being somewhat dismayed at this discussion about an ill woman, not to mention the notion that a person could be 'signed-in' at the proverbial drop of a hat.  That kind of thing did happen in the last century.  That it was even mentioned as a possibility shocked me.  I wished to dispel that.  That's all.  Neither would I give advice in an area about which I knew nothing more than the average lay person - Finance, IT, Insurance, Engineering, Accountancy, etc etc.   That list is quite long!  

The brainstorming has come up with some good suggestions but unless the person concerned *chooses* to co-operate, there is nothing anyone can do.  OK?  

8)


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## ClubMan (19 Mar 2005)

*Re: Morbidly Obese*

Sorry - I wasn't having a go at you but was just clarifying my position. No offence intended. I agree that there have been some useful suggestions here and that it's difficult to come up with the "right" answer at such a remove and with only partial information (not to mention that most of us are not experts/practitioners in this area). I know first hand how difficult it can be to deal with issues of depression and related illnesses with compassion, pragmatism and efficacy. There is definitely no "one size fits all" solution in this sort of situation. I am heartened that such a topic, which I was afraid might attract the "wrong" sort of attention when it appeared, has actually elicited such constructive and caring responses. I must remember this next time I argue that _AAM_ should be restricted to financial topic only!


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## delgirl (20 Mar 2005)

*Re: Morbidly Obese*



> If you want to help your relative just remember that however well intentioned you may be, "help" is not always welcome



Absolutely correct Sherib - it's very difficult to help as 'help' is construed at times as 'pity' and is generally not well received.

I am extremely grateful for the, as Clubman says, constructive and caring way in which you have all responded to this thread and, difficult as it might be, intend to continue with gentle suggestions in the hope of assisting in some way.

Sectioning is not an option, although she is obese and short of breath, this person is highly intellegent, alert and not suffering, I believe, from any form of mental illness other than depression.  I'm not making a diagnosis here, that's just what I see.

The fact that she is, imho, so intellegent is in itself part of the problem and the reason why she is so reluctant to accept assistance.  She's more inclined to listen to a professional than a family member and if we could just find one who is willing to persevere and follow-up on her treatment, it would be half the battle at least.

Once again, thanks for the suggestions.


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## rainyday (20 Mar 2005)

*Re: Morbidly Obese*



> A few years ago, under the VHI, people could go there for treatment and usually were in for 3 weeks to begin with. I don't know how they continued the treatment after that. Then the VHI pulled the plug because they decided people were availing of a 'holiday' - (in a private hospital)! There are ways around this if you have private health insurance if you are being treated for 'something else' that necessitates in-patient treatment and can as a separate issue be treated for one of the 'causes' of the symptoms - i.e. obesity. You need a sympathetic GP and if the one you have isn't find someone else.


While I'm not insensitive to the plight of the original poster, wouldn't it constitute insurance fraud to get treated for 'something else'?


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## ClubMan (20 Mar 2005)

*Re: Morbidly Obese*

This might be a contentious suggestion but might it be of some help to show this topic to the person in question assuming it doesn't compromise your relationship with her or otherwise cause problems?


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## Tonka (21 Mar 2005)

*Sectioning et al*

This is thankfully not what it used to be, a life sentence in an institution  ...often on the whim of a relative.

It is for a situation where the person afflicted WILL not help themselves. 

If the 'situation' were a year or two old I would not contenance or recommend it but if it went beyond that, and the victim still refused to engage with the IDEA of treatment then something has to be done for the sake of all concerned parties .

I am also very confused about the Husband and his side of the argument ...if any......and if none why not ?


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## Tonka (21 Mar 2005)

*Specialist Help*

A psychiatric social worker can be great in these situations .


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## delgirl (21 Mar 2005)

*Re: Specialist Help*



> I am also very confused about the Husband and his side of the argument ...if any......and if none why not ?


It's a complicated situation involving sporadic, very violent outbursts, that has been on-going for over 20 years.  He has been 'shell-shocked, brain-washed, terrorised, conditioned' into not rocking the boat and is very aware of what triggers  these outbursts and avoids it where possible.

He is very isolated - she has over the years succeeded in alienating family and friends from herself and him - my contact with him takes place thru e-mails at work or whenever he calls on his mobile.

He is my primary concern - he is a good, kind, gentle, caring, considerate, fantastic person and has had a very unhappy life due to the problems his partner has.  If I can suggest some form of help for her, which will in turn benefit him, then that's my main aim.

There are times when I fear for his sanity and even his very life when things aren't going well for her and feel that residential care in a clinical environment where all the services she needs can be provided under 1 roof may be the catalyst to change her life and make his more bearable.

If he doesn't feel able to broach the subject of residential assistance with her, then I think Sherib's suggestion for her to see an Endochrinologist might be a good place to start.


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## Janet (21 Mar 2005)

*Re: Specialist Help*

With regard to locating residential type programmes you could also try contacting RTE - they had (have?) a programme called Health Squad where a group of people take someone in hand and take a holistic approach to improving their health/life through exercise, change in diet, alternative therapies etc.  Not saying you should send her off to the telly, just think that they must do some kind of research for the program and could be a good source of information (assuming they'd be willing to share!).  Similarly the UTV (?) programme Celebrity Fit Club might be worth contacting with a "where can I do that" kind of query. 

I really feel for her as this sounds very like me albeit a more extreme version.  Someone posted above that the depression will need to be treated first.  Actually, it probably can't be treated in isolation at first because everything will be so connected - it's a very vicious circle and all aspects will need to be treated simultaneously I would say.  When it comes to overeating and depression it can be something of a "which came first, chicken or egg" situation.  Also, the fact that she is very intelligent could be a hindrance in that she is probably capable of rationalising a lot.

As a matter of interest is she at all interested in changing?  Why does her husband think she would agree to going to a residential programme?  Or is it something they've discussed and she's fully behind it?


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## delgirl (21 Mar 2005)

*Re: Specialist Help*



> Actually, it probably can't be treated in isolation at first because everything will be so connected


That's exactly why I thought residential care where there would hopefully be a dietitian/nutritionist/personal trainer for the weight loss, a psychologist/counsellor for the depression and a medical doctor to evaluate the physical condition and help deal with the nicotine addiction.

She's tried going to the gym, but felt that everyone was looking at her because she's so overweight.  She's tried going for walks and found (real or imaginary?) people staring and children laughing at her.  If her self-esteem could somehow be improved, perhaps the other problems could be resolved.

I haven't managed to put the residential idea to him yet as I was trying to gather some information first. I'm sure he'll have to wait for the right time to suggest it.  I might get a brochure from a clinic or private hospital which he can pop into the Sunday paper, along with the other leaflets, and pretend it came with the paper.  That's unfortunately how difficult it can be to help.


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## Janet (21 Mar 2005)

*Re: Specialist Help*

It sounds like on some level she's not happy with the way she is and wants to change so that's good at least.  Maybe he could even start with something like a week or two at a luxury health spa - this is something that would be a treat (and if he's just come into some money no reason why he shouldn't be treating his wife) more than anything else but it would get her out of her routine as well as having probably healthier food served up to her.  And being pampered, if she can relax enough to allow herself to be pampered (not as easy as it sounds when you're overweight and self-conscious about it).

Reiki is something which she might find useful - it's not just a relaxtion treatment, it is a form of therapy and if she found a good practitioner then it might at least get her used to the idea of talking to someone.  Also, as you don't need to get undressed, she might be more comfortable with this.

I would also suggest that her husband consider counselling himself.  It makes more sense for him to sort out his issues and getting professional advice with regard to helping his wife and how to approach that.


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## ClubMan (21 Mar 2005)

*Re: Specialist Help*

*She's tried going to the gym, but felt that everyone was looking at her because she's so overweight.*

For what it's worth there are ladies only gyms which some women might prefer.

*Reiki is something which she might find useful*

Personally I'd be very skeptical about _Reiki_ and believe that people should be particularly wary about recommending this sort of "treatment" for people suffering from serious mental and/or physical illnesses.


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## Janet (21 Mar 2005)

*Re: Specialist Help*

Fair enough Clubman, a lot of people are skeptical about it.  I've found it helpful, it was something I did as I wanted help relaxing - I was in very stressful job that I hated and the centre I went to happened to be very close to work, it was reiki or a massage and I decided to try something new.  The fact of having someone to talk to was something I hadn't expected and going for reiki sessions played a big part in my decision to finally go for counselling with a registered psychologist, something I'd sort of intended to do for years but never gotten around to.  Many people do feel there is a stigma attached to attending a psychologist and are reluctant to do so.  As reiki is an alternative treatment primarily intended for relaxation it may be more "acceptable" to someone wary of trying "normal" counselling.  I wouldn't suggest that reiki is going to cure disease but I don't believe it's a waste of time and money either.


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## stobear (21 Mar 2005)

*Re: Specialist Help*

Mrs Bear went to Reiki a few times, said it was beneficial. In my narrow minded viewpoint on this treatment I thought that lying on a bed for 45 minutes probably played a larger part in her relaxing than the treatment itself, but who knows. The fact that she stayed still for that length of time at all was a miracle


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## Tonka (22 Mar 2005)

*its is all interconnected.*

Dunno Delgirl. This is a hard one. 

The psychology is related to the self image which appears founded in fact and this feeds back into the psychology and so on, a vicious vicious circle if ever I saw one .

Psychiatric Social Workers can be useful because they are an informal outreach from the formal Psych Units and can advise the husband as much as the victim on all the available options......franlkly they are both victims at this stage and he should go to one in his own right 

A Psychiatric social worker may find a treatment programme that suits her;  ostensibly for Obesity but also capable of dealing with the underlying issues which may be hormonal (endocrine) and/psychological but underlying the condition in any case. 

Janet made the excellent point that any form of therapy , however flaky sounding it may be to those of us who are healthy, can have the desired side effect of forcing her to communicate with professionals for the first time in a long time and can become a key catalyst for self help .  

It would also be a good idea for HER family to step in to back her husband up on whatever sequence of treatments is recommended because it seems to me that the greatest wrong is to do nothing in this case whether motivated by fear or otherwise.


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## ClubMan (22 Mar 2005)

*Re: Specialist Help*

I think we've been over this before...  

*Many people do feel there is a stigma attached to attending a psychologist and are reluctant to do so. As reiki is an alternative treatment primarily intended for relaxation it may be more "acceptable" to someone wary of trying "normal" counselling.*

Again I think that people need to be very careful about comparing/equating "treatments" such as _Reiki_ with those that are based on some sort of objective, scientific, proven grounds such as many counselling/talk therapies.

*I wouldn't suggest that reiki is going to cure disease but I don't believe it's a waste of time and money either.*

In the absence of evidence or first hand experience I would be very skeptical about _Reiki_ and many other alternative/complementary "treatments" yielding anything other than placebo effects at best, if even that. Of course if they do yield positive placebo effects well and good but there is no reason a priori to expect such an outcome. Anecdotal reports of positive experiences do not obviate the need for independent, objective, scientific evidence of how such "treatments" work and, to date, such evidence simply does not exist.


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## delgirl (22 Mar 2005)

Considering the high number of views on this topic - here are some links I found helpful and which may be of interest to others:

National Obesity Forum
Weight Concern
Weight Wise
[broken link removed]

With the rapid rise in numbers of obese persons in Ireland, maybe the next business boom here will be in private obesity clinics covering not just weight loss, but also the underlying causes?


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## holly23 (26 Mar 2005)

Delgirl,

You could try the Ruthland Centre in Dublin (ruthland@aol.ie)
They run residential programmes for those addicted to alcohol, drugs, gambling and food. They also provide family assesment, pre counselling and support.


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## holly23 (26 Mar 2005)

Sorry spelt that incorrectly it should be rutland@aol.ie

Heres a link
[broken link removed]


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## delgirl (26 Mar 2005)

Hi Holly23,  this look really interesting and I think she'd probably be more comfortable with care in Dublin than mainland UK.

Thanks for your help.


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## Gordanus (30 Mar 2005)

you could try looking up evidence based medicine/psychiatry/psychology for recommended treatments for both obesity and depression.  There are an awful lot of well-meaning but ineffectual therapies out there.   If memory serves me right, the National Institute for Clinical Excellence in the NHS provides guidelines.  After that try the NIBPS (N.Ire British Psych Society) who should know of reputable places for treatment.  The various Priory HOspitals should provide suitable treatment, but I strongly urge you to check out the various options and discuss them with your relative and/or her husband.


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