Eating disorders (EDs) are serious and complex illnesses. But problems within the health care system — waiting lists, lack of funding, lack of local specialized services, lack of data — complicate the situation even more.
EDs have the highest death rate of any mental illness (and higher than the general population) due to a combination of medical complications and suicide.
Of the nearly 4,800 licensed psychiatrists in Canada, only slightly more than a dozen specialize in eating disorders.
Ten% of people with anorexia nervosa will die from starvation or medical complications within 10 years and 1% of those with bulimia will die within 10 years.
Research suggests it takes two to seven years to recover from an eating disorder, and only 50% fully recover.
As an eating disorder support worker, Emily Tam is well aware of the weaknesses in the Canada’s health care system — and the consequences for people with eating disorders.
“They feel there is no option. With the existence they have now, there’s so little hope for them,” said Tam, a client support worker with the National Eating Disorder Information Centre (NEDIC) in Toronto, Ontario, in an interview with JOURNEY Magazine.
“. . .the path to the best outcome is getting a quick diagnosis and treatment as soon as possible.”
“For pretty much any of the OHIP-covered programs or any government-funded programs across Canada, there are lengthy waiting lists,” she said.
“There is not much funding towards finding treatment that can really help people recover, partly because it’s just not seen as a priority compared to other mental illnesses, like depression. People are having difficulties, running into barriers to finding care they can afford in their community without having to travel long distances.”
The high mortality rate is due to the toll ED’s take on the body from starvation and purging behaviours, Tam continued.
“And suicides are due to a sense of hopelessness, because people can’t get treatment. Private treatment clinics, whose centres are not covered by provincial health plans, have fees that are out of reach for most people.”
“I think it is also worth highlighting that there are no specialized government-funded services in the Territories, and no specialized government-funded in-patient services for adults in the Atlantic provinces,” Tam said. “This means that those with severe eating disorders living in these parts of Canada must seek treatment outside their home province or territory, which can be a very difficult process.”
On the subject of media and its role, Emily Tam said it is important for people in media to be mindful, not only about the potential harms of perpetuating messages that certain body types (lean, toned) are the most attractive, but also of perpetuating messages that people with these body types are necessarily the healthiest.
Research shows that people can be “overweight” or “obese” as per their body mass index, and not have any more markers of ill health than people of “normal” weight, she said.
“And yet we are surrounded by messaging that we must do whatever we can to avoid being ‘overweight’. Media messages that equate thinness with good health can then contribute to people engaging in potentially risky weight control behaviours motivated, not by an appearance goal, but by a desire to be healthier,” Tam continued. “Moreover, the labelling of foods as ‘good’, ‘bad’, ‘clean, ‘poison’, and so on can instill in people anxiety and fear around eating, which can in turn lead to increasingly restrictive eating behaviours.”
A national registry for eating disorders is also needed in Canada, because there is no data on the number of eating disorder sufferers, the average wait times for treatment, or the percentage of patients who get treatment, psychiatrist Dr. Wendy Spettigue told a parliamentary Status of Women committee in 2014.
In Peterborough, Ontario
In Peterborough, Ontario, Shannon Moloney is a nurse practitioner with the outpatient pediatric (18 and under) and adult (18 and over) eating disorder programs at Peterborough (Ontario) Regional Health Centre (PRHC); Robyn Stone is a social worker with the outpatient adult eating disorder program at PRHC. They are part of a multi-disciplinary team at the hospital which treats patients with eating disorders, as the regional centre for four counties: Kawartha Lakes, Haliburton, Peterborough and Northumberland.
“You cannot tell by looking at someone they have an eating disorder. Sometimes they don’t even know themselves,” said Moloney, in an interview.
She said there is definitely a stigma, especially among adults. “People will come into the centre and say, ‘I’ve never talked to anyone about this. I know I should be eating better, but I can’t’.”
Patients must be “medically and emotionally stable” to take part in the programs, which means if they require advanced care they will be referred to other hospitals in Toronto and Ottawa which provide day treatment and/or intensive inpatient services. There are a limited number of specialized eating disorder treatment beds at these hospitals, and their wait times vary, Michelene Ough, communications lead for PRHC, told JOURNEY Magazine in an email.
There are no waiting lists for either the pediatric or adult programs in Peterborough. Adults can self-refer and be assessed within two weeks. Depending on the recommendation of the team — social worker, dietitian, nurse practitioner, family doctor — which is based at the hospital’s Women’s Health Care Centre, they can attend group or individual counselling, and receive help with medical treatment, all in a multi-disciplinary fashion. Cognitive behavioural therapy is the “gold standard” for adult treatment, said Stone.
Children can be referred by anyone — such as their school, parent, a social worker or doctor. They will be seen within six weeks at the hospital’s Family and Youth Clinic, and be introduced to Family Based Therapy which puts parents at the centre of their child’s treatment, instead of health professionals taking the lead. There are no parent support groups in Peterborough now, but they hope to have some in the future, Moloney said.
Eating disorders are hard to treat and many different treatments are needed, she continued, because, as well as treating the mental illness, patients must also be treated for physical complications, such as starvation.
“The brain actually changes. So the patient is not at a high potential to use the treatment tools and retain and use information we provide,” she said.
“But the path to the best outcome is getting a quick diagnosis and treatment as soon as possible. We’ll assess anyone. Anyone with any issues.”
Call the Women’s Health Care Centre at (705) 743-4132 or 1-800-419-3111 to access services for adults.
Contact the Family and Youth Clinic at (705) 876-5114 for information about services for young people.
NEDIC Helpline open until 5 p.m. EST. Toll FREE: 1-866-633-4220. Toronto: 416-340-4156.