Status of Women Committee on Feb. 24th, 2014

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Two hundred children. I am so sorry.

If you could make a very specific recommendation to this committee, what would have prevented that? What's the recommendation you would make?

[Dr. Wendy Spettigue]

Well, funding. It's tough because I know that there's not enough funding for a lot of areas in health care, but for sure there's just not enough for eating disorders.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So it's about funding.

You listed off which provinces lacked a specialized multidisciplinary centre for childhood eating disorders. What's the recommendation to this committee?

[Dr. Wendy Spettigue]

We certainly need help at all levels. We certainly need more specialized, multidisciplinary teams like the one at CHEO. They need to be bigger and have more services, and we need more of them, but there's no doubt that we also need more services in the community. As I said, if we're only treating the most severely ill patients, then who's going to treat all the others?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thanks. I'm going to pick that up. It really ties in with what Dr. Votta-Bleeker said.

You mentioned how cuts to secondary and tertiary care have impacted eating disorders. Could you briefly describe that, and then say what the recommendation is, please?

[Dr. Lisa Votta-Bleeker]

I'm actually going to ask Dr. Tasca to speak to the cuts in a moment. But I can definitely say that for us, from an impact perspective, we're here, we're specialized in the assessment, the diagnosis, and the treatment. We can assist in the research on where the gaps are in terms of what we need to do. We're scientific methodologists; that's what psychologists are trained to be. We're also clinicians, so we can assist in the assessment, the treatment, the diagnosis, the consultation, the education, the service delivery, the program evaluation.

We just want to be integrated into the primary teams, and then funded in that capacity.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So should the recommendation of this committee be that psychologists should be considered a basic health care service and part of a multidisciplinary team?

[Dr. Lisa Votta-Bleeker]

Absolutely.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

That's a recommendation you want to see in the committee.

[Dr. Lisa Votta-Bleeker]

Yes, absolutely.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

Okay, to Dr. Tasca then, regarding the cuts to secondary and tertiary care and their impact on eating disorders....

[Dr. Giorgio A. Tasca]

I work at the tertiary care centre in the Ottawa Hospital's eating disorders program. I've been there for 17 years.

We've seen cuts over that time. We lost an OT a couple of years ago, an advanced-practice nurse, half of a psychologist position. It's like death by a thousand cuts, constantly being shaved back a little bit at a time with each new budget.

The hospital budget has not increased for the past three years, and we don't see it increasing for the coming years. That actually means a 3% budget cut, because that's the minimum increase in health care costs for a hospital. So I fully anticipate that our eating disorders program is going to be cut again this year, and probably again next year.

That's meant fewer services. That's meant our outpatient program is much smaller than we hoped it would be. Our day hospital is getting thinner—pardon the pun—and the in-patient program is really minimal, from my perspective.

We also don't treat binge-eating disorder. Binge-eating disorder is the most common eating disorder among adults—

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Then why don't you treat it?

[Dr. Giorgio A. Tasca]

We don't have the resources.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

What is the recommendation to this committee, then?

[Dr. Giorgio A. Tasca]

There should be funded treatment programs for binge-eating disorder. I've run three clinical trials funded by the Canadian Institutes of Health Research and the Ontario Mental Health Foundation. These are research-funded trials, psychotherapy trials for binge-eating disorder.

As soon as we advertise that there is a clinical trial open for binge-eating disorder, we're overwhelmed. We don't spend any of our advertising budget from those trials, because there are just too many people out there who want treatment.

So that's a specific recommendation I would make.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

The last thing I'm going to ask about, which we have heard over and over as a recommendation, is having a national registry. Dr. Phoenix, you talked about that.

I'm wondering if you could all put your wish list in to this committee about what a national registry would include. If there are things you haven't been able to say today, please know you can send in extra material to the committee.

What would you like in a national registry?

[Dr. Wendy Spettigue]

For sure I would want a centralized database. I'd want to be able to track eating disorder patients and their progress, their numbers. Separate from that, I agree we need practice guidelines. We need more study of effective treatments, and the dissemination of all of that, tracking the outcome of patients with eating disorders.

[The Chair, NDP, Hélène LeBlanc]

Thank you.

Did you want to briefly add something on Ms. Duncan's question, Ms. Phoenix?

[Elizabeth Phoenix]

I will.

My final comment was about a recommendation for a research chair for eating disorders and a centre of excellence for eating disorders for Canada.

I think that would be a great first step to facilitate a tracking system and a national registry, and oversee a lot of the gaps and the components that all of the speakers have talked about today. We have a lot of catching up to do regarding research into treatments, understanding etiology in a more efficient way, really tracking how our patients who are receiving treatment are doing, and what that full continuum of care could look like—from outpatients to more intensive services—and how best to serve people from B.C. to Newfoundland.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

Mrs. O'Neill Gordon, you have five minutes.

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

Thank you, Madam Chair.

Thanks to all of you for being with us this afternoon. We certainly appreciate your time. It is so important for everyone to become more and more informed on this disorder. We are learning this by our study, and certainly valuing every day that we spend studying this.

To Dr. Spettigue, we certainly know what an important role that parents and family play in this. In my experience, however, I have sometimes found that parents have had a very difficult role in dealing with it, and go to the point of maybe even trying to keep it hidden. I'm wondering what help they are offered in the form of counselling and the means of getting to accept this disorder, and how you work with them as well.

[Dr. Wendy Spettigue]

Every patient at CHEO in our eating disorder program gets family therapy. This means there is a therapist who is mostly with the parents, working very closely with them to educate them and to raise their anxiety about the severity of the illness in their child and the need for very intense intervention, and to try to empower them to take control over the child's nutrition and to not give opportunity for symptoms. Given that it's a combination of an obsessive-compulsive illness and an addiction where the patient is compelled to have symptoms, we really want to then have parents in charge of just not giving opportunity for symptoms.

As you suggested, though, first, it's a lot easier said than done, and second, not all families have the resources for whatever reason. The parents may have mental illness, or they may be single parents and may not be able to get off work or whatever. That's one of our problems. In the best circumstances maybe 70% will respond to FBT, and it may take over a year. But what do we do with the other 30%? We don't even have the research to tell us what to do with them.

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

I found that in my acquaintance with one family in particular, even the siblings, the brothers and sisters, were having a very difficult time in dealing with it. Are they included as well?

[Dr. Wendy Spettigue]

Yes, and they should be. I agree.