The first time Shaely Ritchey was hospitalized for an eating disorder she was 12 years old.
“It was anorexia nervosa, but I didn’t know what it was. I didn’t know what calories were,” Ritchey said.
Anorexia is one of many eating disorders that affect more than 3,000 people on Vancouver Island, and yet there are only two public inpatient beds located at the Royal Jubilee Hospital in Victoria.
The most recent data available for B.C. comes from 2008 and indicates that 60,000 people across the province live with an eating disorder. Today, there are a combined 47 inpatient, residential and tertiary beds available for treatment, all in either Vancouver or Victoria.
“There’s a lot of stigma in health care still. It’s still largely seen as a personal choice,” Ritchey said. “There’s a huge focus on weight but it’s not a weight disorder, it’s a mental health disorder.”
Conversely, the Ministry of Mental Health and Addictions doesn’t play an active role in eating disorder treatment. Instead, treatment options are a compound effort by the Ministry of Children and Family Development (MCFD) when patients are children or youth, and the Ministry of Health if they are adults. These services are supplemented on a local level by the Provincial Health Services Authority, the BC Centre of Excellence in Eating Disorders, and community programs provided by the MCFD through the Child and Youth Mental Health teams.
Rather than proving to be a strong and multi-faceted effort by this combination, however, the results can often be disjointed to the point that governing parties even know how much funding is put into eating disorder treatment in B.C.
“While some of the funding is provided through contracts or directly attached to an eating disorder program, others are provided on a more individual basis by many CYMH clinicians on teams that don’t have formal programs, especially in smaller communities,” the MCFD said in an emailed response. “This makes it difficult to provide an accurate funding amount for eating disorders alone.”
The Ministry of Health couldn’t confirm numbers more recent than 2016/17, but estimated that public health authorities spent approximately $10.1 million on inpatient and outpatient services.
From her own experience with treatment, Ritchey said there are limited resources, and a poor understanding from some health care staff about the complexity of the disorders.
“One piece of the hospital that I think was appalling was the psychiatric emergency room… I would never want someone to struggle there,” Ritchey said. “Some staff have made very harmful statements like ‘if you’ve chosen to starve yourself there’s nothing we can do.’”
|Shaely Ritchey is the president of the Vancouver Island Voices for Eating Disorders (VIVID). She was first hospitalized for anorexia nervosa when she was 12 years old. ‘I didn’t even know what calories were,’ she said. (File submitted)|
Outpatient services are also oversubscribed and underfunded, Ritchey said.
While the Ministry of Health reported that the two beds in Victoria don’t have wait lists, the ones in the Lower Mainland can range from five to 89 days.
Outpatient services are more readily available in community centres, but depending on the location and severity of the disorder, correctly corresponding treatment might not be accessible.
Ritchey noted that a large aspect of the Jutland outpatient program in Victoria, and at residential treatment centres in Vancouver, is a focus on gaining weight. If patients don’t meet their weight goals within a short period of time they are discharged.
“They kind of need you to be better to even get treatment,” she said.
The MCFD said weight-gain is not the only issue when deciding if a person should be kept in an outpatient program.
“Weight restoration is complex and would not be the sole factor considered as part of a comprehensive treatment plan. Motivation for recovery and compliance with the program expectations are critical factors as well,” a spokesperson for MCFD said.
Still, Sally Chaster has lived with an eating disorder for over 50 years and said she was prematurely discharged from the Jutland outpatient program two and a half years ago.
“I was terminated in full-blown relapse from the Jutland program, and within a matter of months I was an inpatient at my lowest weight here in Victoria,” Chaster said. “The problem is I have over five decades of eating disorders and a 15-week program won’t do anything for me but send me back in a new body with old triggers.”
Chaster argued that eating disorders are rarely ever a stand-alone issue.
“It’s kind of like whack-a-mole; you go somewhere for your eating disorder and suddenly your depression and trauma come up. You deal with your trauma and then your eating disorder comes up,” Chaster said. “You just can’t get anyone to treat a whole person, but you need a team.”
Island Health said that they do try to explore the multi-faceted face of eating disorders.
“The goal of eating disorder care is to help patients find the right service at the right time to best suit their needs and help them move towards recovery, however that looks different for each individual,” said Island Health spokesperson Meribeth Burton in an emailed statement. “We rely on the guidance of clinical experts to assess patients for the appropriate level of treatment and support.”
Regardless, Chaster felt that any treatment options available also seem to cater to one eating disorder archetype.
“Treatments are designed for very emaciated, young White women. Just imagine how many different people don’t fit into that treatment?” Chaster said. “There needs to be more for different ages, races, ethnicities, and religions that require fasting.”
As an older adult Chaster has hit walls in her treatment, especially in residential treatment centres where people live in a group with an extensive list of rules that she feels are condescending for adults, including not being allowed to have visitors in a private room.
“I remember being there once and seeing two younger women sitting next to one another measuring their thighs and comparing them,” she said. “Yet I can’t speak with visitors on my own.”
Chaster also said that clinicians talk to older people with a younger generation’s goals in mind.
“As grown adults we’re not looking at future-oriented goals, we’re looking over our shoulders at things we didn’t do,” Chaster said. “We didn’t have relationships, we didn’t have children, a higher education. Maybe a marriage has fractured under the stress of the eating disorder. Younger people are more forward looking; we need a kind of treatment that helps us from our perspective.”
Regardless of the shortcomings they see, both Ritchey and Chaster conceded that they owe their lives to the resources that do exist.
“I don’t think things are perfect… but basically the hospital stopped me from dying,” Ritchey said. “We’re really just keen on improving things.”
Ritchey and Chaster are now both leaders in the Vancouver Island Voices for Eating Disorders (VIVID), a grassroots eating disorder support group.
More than 1 million people live with eating disorders in Canada. The number is likely higher, as many people fail to recognize the signs of an eating disorder, or do not wish to share their struggles publicly.
The 47 inpatient and residential treatment beds available in B.C. include two beds at the Royal Jubilee Hospital in Victoria, seven tertiary care beds at St. Paul’s Hospital in Vancouver, 10 community beds at the Discovery Vista House in Vancouver, 14 community beds at the Looking Glass Residence – a residential program in Vancouver – and 14 tertiary care beds at the BC Children’s Hospital.
Eating disorders can be life-long conditions, and fatal if left untreated. Anyone seeking help or information can visit keltyeatingdisorders.ca
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