Thank you.
As a tertiary care nurse practitioner, I bring 22 years of mental health experience to this consultation session. During my career I have been a part of system and program development in geriatric mental health, adult mood and anxiety. I spent nine years as a pediatric mental health nurse practitioner, and two years as an adult eating disorders nurse practitioner. Along this journey I have been a witness and influencer of implementing evidenced-based mental health treatment. This is a value I hold very strongly as a right for all our mental health patients and families to receive the best of care and the most appropriate level of care. This has lead me to believe that quality research and evidenced-based treatment should inform and guide practice. This evolves from effective training and knowledge dissemination. This body of research should guide policy-makers and decision-makers in the development of programs.
How can this happen? It commences with the collection of research and expert input, such as what we are engaged in today, and it continues with the commitment to excellence in treatment that is the right of all our patients and families.
My additional comments are going to be structured based on the three asks that have been brought forward by previous members consulted before.
Family physicians and nurse practitioners are well positioned as primary care providers to screen and diagnose eating disorders. It is imperative the current and new diagnostic criteria from DSM-5, which was published in May 2013, be taught in education programs and also to practitioners currently in practice. In particular, an existing barrier to timely referral of individuals with eating disorders is the preoccupation by primary care providers with weight and seemingly normal blood work. When weight and blood are within normal limits practitioners, patients, and families can easily think that the individual is still well. Current DSM-5 criteria remove the stringent weight criterion and the amenorrhea, or loss of menstrual cycle, diagnostic measure that previously we had to work with.
Physicians and nurse practitioners need to better understand and communicate to patients that although their blood work can seem normal, their body stores of these elements are significantly depleted and a reflection of their malnutrition. So they may appear to be a healthy and normal weight, but indeed they are not. More telling of their clinical impairment are their thoughts and feelings about their body shape and weight, and their impaired relationship with food. Clinically I have seen this time and again with our patients who are normal weight and have normal blood values.
An 18-year-old I co-treated this past year with our in-patient medical team met this description—