Status of Women Committee on Feb. 10th, 2014

[Dr. Gail McVey]

I'd like to add a comment, please.

One way to look at it is that often in severe cases of eating disorder, medical stabilization and psychiatric stabilization are warranted. We very much rely on our colleagues working in tertiary care hospitals to deliver that expert care, but all too often, with the limited funding and resources that we have, there are very few dollars left over to help people with that. The medical and psychiatric stabilization just helps a person maximize the use of outpatient treatment, if you will, and some of the issues to look at the root causes of the eating disorder, or how to overcome the eating disorder, and we often don't have very much funding left over for those outpatient services.

I would agree with some of the other witnesses in their statements that we are lacking in terms of the pre-hospitalization, the follow-up to hospitalization, and as I mentioned in my presentation, targeted prevention, which is really catching young women and men at the onset of their symptoms and trying to actually prevent them from developing into eating disorders in the first place.

[Niki Ashton, NDP, Churchill, MB]

It's very surprising to hear that you run simply on donations. It really does seem that the federal government could play a role in terms of funding in the case of this work. We are concerned by the lack of funding this government has put toward eating disorders. We're also concerned by the lack of funding put toward eating disorders from all levels of government.

Last week we heard compelling testimony from Merryl Bear of NEDIC, the National Eating Disorder Information Centre. She talked about how sparse and unsustainable the funding model is for places like Sheena's Place and for her organization. She puts the lack of funding inside a cultural context that doesn't value women's health care sufficiently. She talked about the government cutting funding to the women's health contribution program and other pockets of money that supported work in women's health.

Would you agree with Merryl Bear on this point? How could better funding contribute to helping those with eating disorders?

[The Chair, NDP, Hélène LeBlanc]

Very briefly, please.

[Dr. Gail McVey]

The one comment I would like to make to support the comments that Merryl Bear at NEDIC made is that certainly in my area, as a person who specializes in prevention research, toward the early and mid part of my career, I had funding from women's...[Inaudible--Editor]...funding agencies. When those funding bodies were depleted or no longer existed, my eating disorder research funding fell by the wayside as well.

I very much benefited from those funding sources. I really think there's a misunderstanding about eating disorders. This is not just a women's health issue. Eating disorders affect all of us. We need to be under the tent of mental health and addiction, and we need to be under the tent of other health initiatives that are being discussed across the federal level.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much, Dr. McVey.

Mr. Terence Young, you have seven minutes.

[Terence Young, Conservative, Oakville, ON]

Dr. Pinhas, I want to know if you have any concerns about the obesity interventions that some health care professionals bring forward and that are amplified by the media, which can create anxiety in the minds of young people, young girls, for example, leaving the impression that all sugar is bad and you should never touch sugar, or that all young girls should have the same body mass index as every other young girl.

Do you have concerns that all those messages are planting the seeds of eating disorders in children?

[Dr. Leora Pinhas]

Absolutely.

I think we've been overtaken by this panic around obesity. There is apparently an obesity epidemic. As far as I can tell, though, the rate of obesity in children is essentially a flat line. In fact, recent data from the United States suggests that in the younger groups of people, it's actually going down, not up. We keep acting like we have to do something to make sure kids aren't fat, but in our rush to do that, we are transmitting a kind of panic. What happens is that kids start to think that fat is bad, that being fat is bad.

You know, there are studies that show that kids would rather have a parent die of cancer, they'd rather lose an arm, they'd rather be hit by a truck, than be fat. Being fat is one of the most common reasons kids get bullied. Other kids feel justified when they hear from their teachers, their doctors, and their parents that obesity is such a horrible thing. They misunderstand that. We need to slow down and think about what we are actually transmitting.

I want to commend Hasan Hutchinson, who presented earlier on, for his public health work that has really worked to try to move the focus away from weight to healthy lifestyles. You can be healthy and fat. You can be unhealthy and thin. You cannot tell what someone's health status is just by one number, and yet that seems to be what we're transmitting. Recently there's been a push to look at physical education and physical literacy, but I have also heard suggestions that we should include people's BMI in their marks in gym class, as if kids have any control over that.

[Terence Young, Conservative, Oakville, ON]

That's bad news. Thank you for a fulsome answer.

Dr. Pinhas, what should be the minimum standard of care for girls and women with eating disorders?

[Dr. Leora Pinhas]

That's a big question. I guess what I would say is that girls and women with eating disorders are entitled to the same standards of care they would be entitled to if they had any other mental health disorder. There should be guidelines in place. There should be treatment options across all spectrums of treatment, and treatment should be available across this country. That is the minimum standard of care. We have evidence-based research in some areas, and where we don't we need to be doing that research. That's the minimum standard of care, I would say.

I could go into detail about the specific kinds of things we need. Sure we need in-patient programs, and yes, we need residential programs, but a lot of what we need is outpatient programs. We need intensive community programs and people who are trained to work with families where they live and provide them the supports they're entitled to in the way they do for any other mental health disorder.

Our kids often are excluded from those services in general mental health units. If a child had depression, you could send the child to the local outpatient mental health program. When they hear that these kids have eating disorders, we're often told that there's no place for them. In Toronto, all the acute adolescent mental health beds exclude patients who have a primary diagnosis of an eating disorder, even if they have other reasons to be admitted, such as suicidality.

I've had some of my colleagues in psychiatry approach me and tell me that they would want to admit some of these girls, but they're not allowed because girls with eating disorders aren't entitled to those beds.

[Terence Young, Conservative, Oakville, ON]

Thank you.

Is this lack of consistent and effective services for our children with eating disorders about money?

[Dr. Leora Pinhas]

It's twofold. Sure, it's about money, but it's also about discrimination. When there is money that is sent to child and adolescent mental health, whether that's federal or provincial, we always look.... Eating disorders are always listed, but when the money gets to the mental health care centres, somehow nothing ever gets developed, not only specialized to treat eating disorders, but even to just incorporate patients who have comorbid eating disorders into the other programs.

It's twofold. One is about how much needs to be put into place, but the other is about ensuring accountability, so that when that money is allocated, eating disorders are invited to the table, as Dr. McVey suggested.

[Terence Young, Conservative, Oakville, ON]

Thank you.

If a doctor or a parent of a child with an eating disorder wanted to find out the cost burden of seeking treatment for their child, which would include transportation, day care, time off work, etc., is there anywhere they could find this information?

[Dr. Leora Pinhas]

Not...[Technical Difficulty—Editor] We don't track that. There's no research to look into that, and it's almost impossible to figure out a way to get funded for that kind of research.

[Terence Young, Conservative, Oakville, ON]

If you wanted to find out how many women and girls have died of an eating disorder in Canada, is there a resource to do so?

[Dr. Leora Pinhas]

No, there is not.

[Terence Young, Conservative, Oakville, ON]

Would a death registry be helpful?

[Dr. Leora Pinhas]

A registry that tracked patients identified with eating disorders, for an unfortunate death, or recovery, or any kind of data that a registry, say, like the cancer registry, could track, but for eating disorders, would immediately improve the state of affairs.

[Terence Young, Conservative, Oakville, ON]

Some of the patients who are treated as in-patients in hospital programs—I'm talking about girls and women—leave and sometimes slip back into their old patterns of purging, etc. What could we do? What could be done or should be done with regard to their care to make their improvements more permanent?

[The Chair, NDP, Hélène LeBlanc]

Very briefly, please.

[Dr. Leora Pinhas]

First of all, it would be great if we even had outpatient programming for them. Many of these women leave in-patient intensive services and go to nothing, so anything we could do, even weekly visits, would be better. Certainly, we could do other things, such as working with them in the community, like they do with addictions or in some other child models, but anything would be better than what we have now, which is nothing.

[Dr. Gail McVey]

Schools are actually reaching out and asking how they can help them re-enter the school system when they are still in recovery or have recently recovered from the eating disorder.

[The Chair, NDP, Hélène LeBlanc]

Thank you, Mr. Young.

Ms. Duncan, you have seven minutes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Dr. Pinhas and Dr. McVey. Welcome to committee.

First, I don't mean to harp on this, but I note that I am waiting for information that I asked for from officials on December 10.

Dr. McVey, I'm wondering if you could tell the committee how many psychiatrists there are in Canada who work with Canadians with eating disorders, please.

[Dr. Gail McVey]

Yes. We have approximately 40,000 to 41,000 psychiatrists in Canada in total. Based on anecdotally looking at our colleagues across Canada, we have approximately 12 psychiatrists who work in the area of eating disorders. That is split between those who specialize in adult eating disorders versus those who specialize in child and adolescent eating disorders.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

That's shocking. Are there provinces where there is not a.... If there's one psychiatrist, the distance people are going to have to travel is shocking.

If you could make a recommendation to this committee regarding psychiatrists who look at eating disorders, what would that very specific recommendation be, please?