Hello, and thank you for inviting me to participate today.
For those of you who haven't met me, my name is April Elliott. I'm a devoted mother of two youths. My profession of 21 years has been as an adolescent pediatrician and founder and head of adolescent medicine at the Alberta Children's Hospital in Calgary, Alberta. I'm also a certified executive coach trained at the University of Berkeley, and I work with physicians to support their burnout and proactively support their career development. I also coach parents to be more successful in their parenting interactions with youth.
As a frontline clinician, I have witnessed a dramatic increase in morbidity and mental health decline in youth from 2001 to the present. The availability of developmentally appropriate resources has not kept up to the rise.
As we all know, the 2020 UNICEF report card shows that Canada is shamefully lower than other rich countries in providing healthy childhoods. Of comparator countries, concerning physical health, Canada dropped to 30th of 38, and for mental health, to 31st of 38.
There are myriad topics related to youth health. This brief statement will discuss concerns related to the mental health of young women and girls, more specifically eating disorders, as this is my area of expertise and it was drastically impacted over the last two and a half years.
In March 2021, I published a paper with Professor Deborah Christie, “A year supporting youth within a pandemic: A shared reflection”, in the Journal of Clinical Child Psychology and Psychiatry.
We summarized the impact of the COVID mitigations, school closures and the mental health impact on young people in the U.K. and Canada. The data began to emerge that the pandemic was causing a range of harms to children, including feeling isolated and lonely; suffering from sleep problems, anxiety and depression; and reduced physical activity.
Charities reported increased demand for counselling, with many young people talking about how lonely they felt. Calls to kids helplines increased fourfold from 2019 to 2020. There was also a risk in harm for those living with emotional, physical and sexual abuse.
Many colleagues worldwide described an “explosion” in eating disorders.
With regard to eating disorders, the prevalence of anorexia nervosa in adolescent females is 0.3% to 0.7%, with an incidence estimated at eight per 100,000. To put this in perspective, this compares to a minimum incidence of 1.54 per 100,000 per year of type 2 diabetes in Canadian youth.
Anorexia nervosa is a complex bio-psychosocial disorder that interacts with pediatrics and mental health. It is an illness that can be debilitating for patients and their families. The majority are young girls and women.
Eating disorders are common and are life threatening. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Mortality is as high as 5% to 7%; some report as high as 18%. With these significant medical and psychiatric consequences, an individual is 10 times more likely to die than their healthy peers are.
Globally we have seen unprecedented numbers of hospitalizations related to new and severe cases. Patients are severely malnourished, with increased medical complications.
The COVID pandemic is a common precipitating factor noted by patients and families. They note school closures, loss of sports, and not being with peers. A recently published Canadian pediatric surveillance program supports this.
These are my recommendations:
One, it is very costly to treat in a hospital setting, so early recognition and treatment by primary care physicians is essential. This education needs to be mandatory in medical schools.
Two is increased resources for timely referral and access to trained and qualified health care providers in delivering evidence-based outpatient treatment modalities for eating disorders.
Let's suppose a young person needs hospitalization for a moderate to severe eating disorder. In that case, they need specialized units or staff on generalized units with integrated training carrying out these guidelines. These are few and far between, and many Canadian cities do not have them. The Alberta Children's Hospital has a catchment area of 2.5 million and has no specialized eating disorder in-patient unit.
With regard to general mental health for youth, I would recommend providing more support for young people. It was already significantly stretched. We must prioritize teachers, school mental health and increased resources. We need to focus on this COVID generation.
Parity of esteem for mental health alongside physical health care is an absolute priority. Health care has a long history of not integrating mental and physical health. There must be significant investment in ensuring timely mental health access for appropriate mental health care where the young person lives in cities or rural settings.
Finally, in addition to bolstering the investment in mental health programs for children and youth, we mustn't forget we need to ensure there is support in place to strengthen and champion increased human and financial resources for health care practitioners in these areas, who are also on the brink of immeasurable burnout.
Thank you.