For people who live in rural areas who need intensive treatment, they have to travel. My catchment area in Ontario covers, for example, most of northern Ontario. People come from many hundreds of miles away to attend my program. That is not ideal. It would be better if they could be treated closer to home. Dealing with remote and rural populations is complicated because the volumes are low in such locations. There aren't a lot of patients. The patients there are just as sick as anyone else, but there aren't a lot of patients, so it can be hard to justify setting up proper clinics for those people.
Having said that, setting up clinics where you teach somebody to do cognitive behavioural therapy for bulimia in a micro-agency with two or three employees, that's dead simple. You can train someone to do CBT very easily. There should be CBT in every community in the country, or available in every community in the country.
Training people in diagnosis in small clinics, that's fairly straightforward. You should be able to do that. I think enhanced awareness of this among family doctors and pediatricians is very important, to at least identify patients and then refer them to the nearest treatment program.
I agree with you that there's a serious problem in terms of access to care for remote and rural communities for all aspects of medicine, not just this.