Status of Women Committee on Feb. 12th, 2014

[Noelle Martin]

I was just going to say, for myself, I am in touch with several practitioners across North America because of opportunities that I've had through attending conferences as well as touring treatment facilities in the U.S.

So I do have the opportunity to communicate with others, but I am sure there could be a greater level of communication, especially within Canada, as the majority of the people who are part of the online community I speak with are from the United States.

So more attention given to the opportunity for communication within Canada would be wonderful.

[Tilly O'Neill-Gordon, Conservative, Miramichi, NB]

I want to congratulate you on the work that you do. Above and beyond, I was happy to hear you share what you do and how you help the individuals with phone calls and sessions, and meeting with parents.

Can you elaborate on the continuing care of those who have received treatment and how they're followed up?

[Noelle Martin]

Absolutely. When I was working in the general community, individuals were able to see me as long as they wished; however, the university clients are able to meet with us for the lifespan of their university career. We have some master's and Ph.D. students who continue to see us throughout their university career.

Beyond that I do make sure that I put them in touch with at least two, if not more, opportunities within their community. So when they find an opportunity for employment or they go home, whatever it might be, I will try to put them in touch with whatever opportunities are available there. The reason I try to find two or more is that not every one is a fit.

The other thing is that in my role as a dietitian, I'm only part of a large team. Psychologists, psychiatrists, and family physicians play a huge role in terms of building a team for healing, really, for the individual.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

I will now give the floor to Ms. Duncan for seven minutes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair, and thank you to both of you for the work you do and for your comments today.

Ms. Anderson, I just want to make sure that we recognize that you've made three very specific recommendations. One is that we need a national awareness campaign; second, we need a national registry; and third, we need a national research program. Did I reflect that correctly?

[Joanna Anderson]

Yes, very correctly, thank you.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So there are three recommendations to the committee.

You also raised a fourth point regarding how we share this, not just in terms of best practices but in terms of collecting the research, one place that people can go. You said an essential database or clearing house. Should that be a recommendation to the committee, to have a national clearing house on information regarding eating disorders?

[Joanna Anderson]

Yes, I believe that would be a very effective strategy for moving forward.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

Ms. Anderson, you talked about private treatment and costs. Can you give the committee an idea of what the private treatments are that people need to pay for? Is it seeing psychiatrists, seeing psychologists, seeing registered dietitians? Give us an idea of what the cost of each of those services is, please.

[Joanna Anderson]

Sure.

Psychiatrists in Canada are covered by OHIP—if you can find one, and if you can find one to treat eating disorders. I would say that within psychiatry, because this is a long-standing, entrenched illness, a lot of psychiatrists don't want to take eating disorder clients on. They view them as high-risk—their mortality rates are very high—and they view it as a very long commitment.

So that's one thing.

Psychologists charge over $200 per session in Canada. I have a private practice where I've followed clients, and I charge $150 an hour. So that's $600 a month if you're going to treatment only once a week, which I would say is not enough when you are in crisis. One hour of counselling a week is not going to do it.

Our clients often need dietitians. Ms. Martin may be able to speak to the rates they charge a little better than I can. But you need a team, as she said. We know that eating disorders are co-morbid with anxiety and depression, and often trauma. We don't have medication to treat the eating disorder—that's food—but what we can use medication for is to control the co-morbid things.

So you need a psychiatrist, you need a dietitian, and you need a therapist. That's an expensive team if you have to pay for it yourself.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

This is very helpful. If you could make a recommendation to this committee—you're talking about a team approach—what would that recommendation be regarding treatment?

[Joanna Anderson]

As I said, we know that shorter waiting lists are consistent with a better prognosis. Either you have this illness for one or two years, or you have it for many years. That's what the data tell us, and that's what we see at Sheena's Place. So in terms of recommendations, I would say shorter waiting lists, better access to treatment, more treatment options. Not everyone can go to a hospital. You go to a hospital when you've become quite medically unstable. We need treatment in the community that is accessible and paid for.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So the recommendation would be treatment in the community that is paid for, acceptable, and with appropriate waiting times, short waiting times. Is that correct, or would you like to modify that?

[Joanna Anderson]

No. I think that's absolutely accurate.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Okay. Thank you.

The people who come to you, is it one group? How does it break down? Is it people who have tried many different services or is it a combination of, you're the first place they come to? I think you were saying it varies. If they've tried other treatments, what are the average wait times for treatment? How long have they been treated? What is the relapse rate? Could you give us a sense of that, please?

[Joanna Anderson]

Sure. I can provide the committee with more numbers. I don't have the numbers exactly off the top of my head, but I can submit them to you.

Many of our clients, I would say about 30%, have had this illness for one to two years. Similarly, another 30% have suffered for more than 20 years. As I said, that is consistent with the literature on eating disorders. That's why we know early intervention and access to treatment is so important. I can't underscore that enough. Our clients have been in and out of hospital for years. They access emergency care because the waiting lists are so long for treatment. They go to the emergency room and that costs the health care system probably millions of dollars.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Should another recommendation be early access to treatment?

[Joanna Anderson]

Absolutely. Early screening and access to treatment.... When I worked at SickKids we did a family meeting every month where we would talk to parents and introduce them to our program. The theme month after month was, "We went to the doctor, we told them something was wrong with our child, the doctor said it's fine, the doctor didn't know where to send us, the doctor didn't know how to treat us."

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So is one of the issues that the first person the family is going to go to is the family physician?

[Joanna Anderson]

That's right.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Is part of this training for physicians to recognize and to screen for eating disorders? Should that be a recommendation?

[Joanna Anderson]

Yes. Absolutely.

Ms. Martin noted earlier about children's growth curves. The first thing that we would always do when we got a child into the program was look at the way they had been growing normally until they had this intervention of an eating disorder. The idea is to get kids back on track of their own growth curve, not on some predetermined weight or shape that they want to be, or that they've decided would be best for them.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

Ms. Ambler, you have five minutes.

[Stella Ambler, Conservative, Mississauga South, ON]

Thank you, Madam Chair.

I'd like to share a bit of my time as well with Mr. Young.

Thank you both for being here today.

Ms. Anderson, I was wondering if I could ask you about the spectrum of severity. We often hear that the disorder starts out a certain way and that only the ones on the most severe end of the spectrum are treated. If the approach is to identify the disorder in its earlier stages, what can be done at that point? We talk about medical treatment, but is there something that parents can do, something that parents can say to make it better, or a change of lifestyle that would help in the early stages?

[Joanna Anderson]

Yes. I think that parents aren't educated around what an eating disorder is, or even what the signs are. That's one thing, to have parents understand if suddenly their child is skipping meals, the lunch containers are coming back with food still in them, there is a problem and it needs to be addressed.

I think that kids go out of their way to hide this disorder from their parents, so working with families just to be educated around it is one important step.