Sure. I'm involved in reviewing almost all the cases in Ontario. There's a panel of us who have a look at the cases.
The most common situation for people applying for out-of-country treatment is that they have never been assessed by an expert in anorexia or bulimia and have never even been offered treatment in Ontario. That's the most common situation.
I refer very few people to the States. I'll refer one or two people a year, people with extraordinarily complex situations, and there are one or two places in the States that have special expertise that can help out. But by and large, referral to the States is not necessary, and the outcomes are awful, partly because patients are not held there long enough. They need to be held there eight or nine months, and they're held there two or three months. Patients come back partially treated; they don't want any more treatment, and they get sick again right away.
Because the access is very quick, if it's granted, you get this subset of people who kind of get hooked on the quick access to ineffective treatment and stay ghettoized into repeated efforts of going into the States. They have a belief that the treatment system in Ontario is bad, and they won't come for treatment when OHIP finally cuts them off. This is actually doing people a disservice, by and large. There are very, very few good outcomes from treatment in the States, because OHIP won't send them there for long enough, and OHIP is confused about what the purpose of this program is. Most people in the treatment programs in the States would stay there 12 to 18 months at varying levels of care. Two to three months is just getting started.