Status of Women Committee on Feb. 26th, 2014

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

Ms. Ashton, you have seven minutes.

[Niki Ashton, NDP, Churchill, MB]

Thank you very much to all of our witnesses who are joining us here today. I'll be directing my questions from my round to Ms. Brayton and as well to Ms. Cairns.

Ms. Brayton, thank you very much for your presentation and for sharing a very clear focus on the experience of women with disabilities. Early on in your presentation, you commented on the importance of a feminist lens. It's not a lens we've heard much, in this committee, at least explicitly. I think we can argue that many of the witnesses shared critical perspectives. How important is it to apply a feminist lens to dealing with eating disorders?

[Bonnie L. Brayton]

I think we should do this given what the statistics show us, which is that while there is certainly, from a gender perspective, a rising issue among men, this is something that is affecting women in mind-boggling numbers. The consequence of this is that the gender analysis and feminist perspective become extremely important around understanding from both an historical perspective.... What's driving this? Again, I made reference to the media and I made reference to a lot of the things that put young women and women of all ages and disability and ability in a position of feeling that they have something to live up to in terms of an image.

I spoke a lot about our concerns around the fact that women with disabilities and deaf women, for example, are not portrayed in the media. The consequence is that they're searching constantly for someone and something against which to measure themselves and they don't find that. Again, I made the other point, which is that the feminist disability lens adds one more dimension to that, which is to understand that often what is a pressure on women with disabilities is to live up to something else, another standard, rather than being accepted and valued for who they are.

[Niki Ashton, NDP, Churchill, MB]

Do you have any sense of trends, perhaps, in the media or social media or in public around the portrayal of women and maybe, specifically, women with disabilities?

[Bonnie L. Brayton]

The only thing I've ever seen on women with disabilities, for example, would be a show that actually is a bit of a bad example of trying to feature women with disabilities. I think it's called Push Girls, a show that was playing on the Life channel last year. I don't know if anyone saw it but again it focused on specifically women in wheelchairs, and again, from a very almost Sex and The City perspective, which was really disappointing. I was really happy to see a portrayal of women with disabilities, but it's one that doesn't give a balanced perspective on the reality that most women with disabilities are facing: poverty, unemployment, high rates of violence. These are all things that are much more their reality than what you're seeing. Again, you just don't see us in the media. It's a big problem.

[Niki Ashton, NDP, Churchill, MB]

Thank you for sharing that. I have one quick question so I get time to ask Ms. Cairns as well.

An issue, of course, that has come up is the question of bodily sovereignty, I guess the range between voluntary treatment and medical professionals reaching the point that people are forced into treatment. Obviously we know if we apply the disability lens it's a very serious issue we need to look at. I'm wondering if you can comment on that.

[Bonnie L. Brayton]

I can. Insofar as forced treatment is a huge issue, particularly for women with a mental health disability, there are so many dimensions to that. We could spend an entire other committee, I'm sure, just on that issue. Electric shock treatment is one of the ones that I think is probably best known to people in terms of forced treatment and that issue for women with mental health problems.

The other thing—and I know you didn't ask about but I wanted to say something on it—is it's really important for people to think about this in the context that you have.... Again, DAWN is a cross-disability organization and what we really hope, and again, what our written brief will reflect, is that these are disabilities already. The mental health disability of these eating disorders exists, in addition to which it's important to understand that there's a whole other perspective that you need to understand from the perspective of women with physical disabilities.

I appreciate very much the question around the treatment issue, Niki, and like I said, it's one issue, but the larger issue is still the attitudinal and physical and all the barriers that women with disabilities are facing in terms of just getting treatment and being recognized as the most high-risk group, in fact, of women for eating disorders.

[Niki Ashton, NDP, Churchill, MB]

Thank you very much. We look forward to the written document and thank you for sharing as well the work of the Ph.D. student.

[Bonnie L. Brayton]

I hope the committee will call the other woman I mentioned; she would be really important to hear from.

[Niki Ashton, NDP, Churchill, MB]

For sure. Thank you, Ms. Brayton.

Ms. Cairns, I quickly wanted to ask about your work and the association's work in identifying the particular challenges that minority populations face in terms of eating disorders and in terms of treatment: aboriginal, immigrant, LGBT communities, people living with disabilities. I'm wondering if you could comment on that.

[Jadine Cairns]

Unfortunately, because of the limited time that the association has been active, we haven't got to those particular topics.

One of our visions is to progress to the place where we can address some of those issues. Even this past year, we were talking about having sessions that can perhaps talk about why it is that we don't have as many people of different ethnicities seeking treatment. Actually, a big topic is involuntary treatment, to go back to the questions you were raising before. Involuntary treatment is something that most tertiary care programs really grapple with.

But those are the areas that we would love to have the opportunity to address, and that's why, with your research, we would love to be a part of and support the process as we talk about people with disabilities or people who are of a different ethnicity. Why aren't they coming for treatment? That's something we have noticed, but as an association we have not had the resources or the ability to address it.

[Niki Ashton, NDP, Churchill, MB]

Just quickly, Ms. Cairns, I wonder if you would agree with others who have talked about the adverse effects of healthy eating campaigns on people who are living with eating disorders.

[Jadine Cairns]

Wholeheartedly, and in fact I was mentioning that I was coming to this meeting and one of my private clients said, “Yes, please tell them that it's really hard on us.” Healthy eating means what? It means that I have to watch my calories, that I have to cut my fat. So wholeheartedly....

I mean, those messages need to get out there—I am a dietician by training—but we need to make sure, as I was mentioning, that we don't just use a broad brush to say that healthy eating is only this: that it's always avoiding fats, that it's always avoiding sugar. What's left? Just protein. It's always exercising....

The health messages need to have this in mind, because our young women and young men are receiving them, and we need to be cognizant of how they may be receiving them and taking them to extreme places.

[The Chair, NDP, Hélène LeBlanc]

Thank you very much.

Mrs. O'Neill Gordon, you have the floor for seven minutes.

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

Thank you, Madam Chair.

I want to say a sincere thank you to all of you for taking the time to be with us today. Our committee has been very focused on this study and has learned much from witnesses like you and others we have had the opportunity to hear. As we all know, it is always great to hear from someone who has worked in this area and has experienced first-hand what eating disorders really are.

My first question is for Mr. Boese. To begin, I want to thank you and congratulate you on seeing the need many years ago and stepping up and doing something about it.

You describe the Avalon Centers making use of a multidisciplinary approach. How did your team come to create this approach? How can we share this as a model with other organizations in the treatment of eating disorders?

[Arthur Boese]

We obtained all the information from Dr. Paul Garfinkel, who was the leading authority back in the early 1980s.

First, I should say that we had two psychiatrists, psychologists, art therapists, and nutritionists, all these people, as part of our program. We had 30 people, so there was a lot of information. They said that it was going to take about three months to get this information to make a partial hospitalization program. At that time, it was a new thing. We're talking about 15 years ago.

I'm hearing a lot of things today that I heard 15 years ago, so not a lot is changing in this whole industry, which absolutely upsets me—I have to hold myself down—because we have to get changes. We can talk about these things. Education is fantastic. I'm told that when Obama got into power he made it law that every doctor had to go through an eating disorder course. So on education, no question.

However, when we got this information from Paul Garfinkel.... In fact, I called him up because my psychiatrist said that it was going to take me three months to pull this stuff together because we had to get it out of the library in Toronto, at the university. Paul Garfinkel said, “Well, what do you need?” I told him and he said, “Oh, that paragraph is in volume 2 on page 27”. He went through the whole thing. Now, he wasn't 100%, but he cut off three months of work. We put it together from that. It probably cost us $200,000 or $300,000 to put a protocol together.

That's what we gave to Homewood in Guelph, which nicely gobbled it up. We had a contract with them. They just took all the information.... It sent us into a bit of turn-spin, because we wanted to open in the U.S. They wanted five things from us. They wanted cutting-edge, which they didn't have. They wanted something that was reproducible, which they didn't have. They wanted something that had a licence, which we thought was a joke. We got the first licence in the State of New York. I could tell you how we got it, but I won't take the time. We really went to the top.

I said that we had a meeting with Hillary Clinton. That was a big feat, too, because we went there to help with mental health parity. I ran into somebody who asked if we had seen Hillary Clinton. When I said no, that she couldn't come out, she took my hand, walked over to a woman and said, “This is Art Boese of Avalon, a friend of mine, and he wants to meet with Hillary Clinton.” Ten minutes later she came back and said, “How about 12:30?” I looked at her and said, “Tomorrow at 12:30?” My wife was with me, I asked her if she thought we could make it, and we had a one-on-one with Hillary Clinton in a room with probably 1,000 people in it. We were in the centre, one-on-one with Hillary Clinton.

I asked that, and she said, “Art, I'm 100% behind you.” I went from there and said that I had two more things. One of them was comprehensive care centres so that patients could move at the rate of the patients' health, not at the whim of the HMOs or the outpatient therapist who keeps them too long.

As I mentioned, we saved 1,000 lives. You hear other things, such as where we've talked to 17,000 people, and that's a wonderful thing, except that we got them when they had failed already from the one-on-one outpatient.... It's important that we have something so that when they do in fact go into.... Normally what happens is that you go from outpatient. Your electrolytes are off and your weight is down. You go into the hospital and they put the weight back on.

The patient thinks, “Wow, did I get help.” But the psychiatrist there checks it off and says, “Oh, Sally was in there.” That's about it. Then she goes back and she fails: now she won't go back into a treatment program.

Somebody called me yesterday before I came out here and said that their daughter had gone to Avalon Hills in Arizona. She had been around for about two years, almost dying everywhere. Anyway, she came out of there feeling great. She went back to her doctor, and her doctor said, “Well, get on the scale and let's have a look.” She went straight back into program. That's all it takes. The education is so important. I always agree that it's important, but we have to do something.

We don't have programs here. We have nothing in Canada, nothing at all. I could scream at the top of my lungs. I work so hard. I work seven days a week. I can tell you that I went through $3 million of my money in this thing, and I see things not moving ahead. I hear the same things that I heard 15 years ago, and I went to a lot of clinical meetings.

I'm sorry to go on like this. Terence, you tell me to keep quiet.

[Voices]

Oh, oh!

[Arthur Boese]

But I went through the clinical stuff. Every week I drove to Buffalo and sat there while they went through an hour and a half with all the staff, because it's multidisciplinary and everybody's going to talk about the patient who's there: the psychiatrist, the psychologist, and the therapist. I got a great education. I'm not a therapist. I was in the valve-and-fitting business. I was not close to this business at all, but I sure learned an awful lot.

But one thing I can do is make things happen. I've had 10 companies in my life. I've made them happen.

I was the first to get the telephone in Canada because they weren't going to do it. I put up the walls on the highways. I was the first one to do that. I went on and on. I can make this happen if you really want it to happen.

We all agree that eating disorders are a problem. There's no question about that. But we can't do anything by talking about this thing and fooling around the outside. You've got to go in and make it happen.

Sorry for that.

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

Ms. Champagne, you mentioned, and we all know, that attitudes are a major factor in this disorder. How would you like to see attitudes changed? What are some of the ideas you have to help us to change these attitudes?

[Josée Champagne]

Over the past few years in Quebec, a movement has emerged out of the Charte québécoise pour une image corporelle saine et diversifiée—Quebec charter for a healthy and diversified body image—which is now called the CHIC. The CHIC was implemented by the provincial ministry of women's affairs. This movement aims to promote a healthy and diversified body image and to encourage the participation of fashion, advertisement, media and health communities. Its goal is to bring together all the partners in order to drive social change and encourage body shape diversity.

This movement is gaining a lot of momentum, and people are increasingly joining in. Leading fashion magazines such as Clin d'oeil have decided to sign the charter. Clothing store Jacob also adopted a non-retouching policy. Mobilization is taking place....

[The Chair, NDP, Hélène LeBlanc]

I have to stop you here, Ms. Champagne. Thank you very much. We have understood and will be able to follow this issue closely.

I now yield the floor to Ms. Duncan, who has seven minutes.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madame Chair.

Welcome to you all and thank you for being here. I'm going to begin with Ms. Cairns.

Ms. Cairns, I'm going to look for short answers. I'm trying to establish numbers. I'm wondering how many publicly funded outpatient clinics there are in B.C.

[Jadine Cairns]

I don't have the numbers at the tip of my fingers, but I can provide them to you.

By region there are at least eight publicly funded outpatient clinics specific to eating disorders.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

How many publicly funded beds for eating disorders are there in British Columbia?

[Jadine Cairns]

There are 14 beds for children and adolescents and six day treatment spaces in the Children's.

In the adult system, I'm not 100% sure. I don't work as closely in that area, but there is an in-patient protocol and Dr. Josie Geller could speak more on that. They use the medical wards.