I'll start by saying that I'm a community-based psychiatrist in Thunder Bay, and I treat depression, anxiety and trauma. My practice is 80% women. My colleague is a child psychiatrist in Sudbury, so we bring some different perspectives.
First of all, I'll talk about the north. Individuals in northern Ontario typically have poor mental health and, in urban areas, higher rates of depression and twice the rate of hospitalization, usually for suicidal concerns, in a very fragmented mental health system—if there is one.
I'm always amazed by how far my patients will travel to get care. It has changed somewhat with COVID, but it hasn't cured everything. I have a lady who comes from a small reserve. Depending on which season it is, she takes either a boat or a ski-doo to the train, which is often six to 10 hours late, and then a van to get into Thunder Bay. Things have improved for her with the different accesses with COVID, but not all of the remote communities have Internet access.
If we move specifically to women, certainly intimate partner violence is a significant issue and is at a higher rate in northern communities and smaller communities, as are issues around transportation and emergency housing. The lady I just mentioned was assaulted by her partner, who was intoxicated, and she held him down until he passed out. It took five days for the police to get to the reserve to take the report—five days. It's a small isolated community of 30 people, just so you know.
On their experience of violence and abuse, there's such a high rate of trauma in the population in general, but in the north it's estimated that 78% have a history of child and/or adulthood trauma, and 16% develop PTSD leading to suicide and self-harming behaviour. We could talk for hours about that. Also, in our indigenous population, we see high rates of depression, with much higher rates of psychological distress, suicidal ideation and suicide attempts compared with men.
Finally, there's the impact of COVID. There have been some benefits, but certainly there have been disadvantages, and there has been disconnection as well. I was seeing one of my patients remotely through what's called the Ontario tele-video network, and what happened in the community was that the office she was using to see me virtually was taken over as a COVID testing centre, so then I had to revert to the phone.
The challenges have been many. I'm going to turn it over to my colleague. He has a few comments about eating disorders, which are a challenge to treat in the north.