WARNING: This article contains details of an eating disorder
When Sally Chaster in Victoria experienced a relapse with anorexia nervosa in April 2021, she knew she wasn't going to come out of it on her own.
She was losing a lot of weight and was very weak.
"During that time, I was in the worst relapse of my life," said Chaster, who was an executive director in the public service before she went on long-term disability due to anorexia.
She participated in a nutrition group and worked with a case manager monthly while waiting to be admitted to Vancouver's St. Paul's Hospital.
She was admitted in December and spent six weeks at the hospital.
"I waited eight months and I thought seriously that I was going to die," she said.
"It's a long time to wait, especially when you're getting sicker and sicker."
Wait times for treatment for eating disorders in Canada have grown during the COVID-19 pandemic.
Psychologists, pediatricians, counsellors and others across the country said they've seen a jump in referrals throughout the pandemic for eating disorders. In many areas, that increase has resulted in longer wait times for publicly funded treatment.
In some provinces, wait times for community-based and outpatient programs can be anywhere from six months to 18 months or longer.
Experts say timely treatment is important so that the behaviours of eating disorders don't become entrenched.
"When you look at disordered eating and the behaviours associated with that, they can intensify and worsen. And certainly the pandemic has contributed to that. So it's really concerning when we look at those wait times," said Julia Klassen, eating disorder counsellor with the community-based Provincial Eating Disorder Prevention and Recovery Program (PEDPRP) in Winnipeg.
Access to those services is not uniform across the country; the territories and some Atlantic provinces are without publicly funded inpatient or residential services for eating disorders.
"Access to publicly funded health care specializing in eating disorders in Canada is severely limited," said Aryel Maharaj, outreach and education coordinator at the National Eating Disorder Information Centre (NEDIC), based in Toronto.
What changed during the pandemic?
Wait times vary across the country and vary based on the treatment options, like inpatient care or outpatient services
Dr. Kathryn Trottier, a clinical psychologist and clinical program lead at the Eating Disorder Program with the University Health Network in Toronto, said the average wait time for their inpatient beds is about two to three months.
But the wait for their outpatient program is now at 18 months, "whereas prior to the pandemic, access to that treatment was pretty timely," she said.
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The wait list for the community-based PEDPRP in Winnipeg has also grown.
"We typically used to be looking at a six to 12-month wait to enter into our program, whereas now we're looking at 18 months or longer," said Klassen.
In Nova Scotia, referrals and wait times have doubled, according to a statement from Nova Scotia Health officials. Wait times for the three inpatient beds in the province are on average one to two months and four to six months to access the eating disorder clinic at the QEII Health Sciences Centre in Halifax.
Dr. Ayisha Kurji, one of only a few pediatricians in Saskatchewan who treat youth with eating disorders, said the number of referrals at her clinic has at least doubled in the last two years.
She said part of the reason demand for eating disorder treatment has increased is because many had their routines disrupted by the pandemic.
"Now instead of having to get up and go to school and have breakfast, have your set lunchtime time … that went away. And that was a big difference for a lot of kids," Kurji said, adding more time during the pandemic to check social media has also been a trigger for many of her patients.
Data published this year by the Canadian Institute for Health Information (CIHI) shows hospitalizations for girls aged 10 to 17 with eating disorders increased by more than 50 per cent since March 2020. The data shows there was an increase from about 52 hospitalizations per 100,000 people in 2019–2020 to 82 hospitalizations per 100,000 people in 2020–2021.
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Dr. Lara Ostolosky, a psychiatrist and medical director for the Eating Disorders program at the University of Alberta in Edmonton, said she recently had to wait to admit a new patient because there was a shortage in nursing staff.
"If we don't have adequate staff, we can't admit safely," she said.
Although there are private options available in many provinces and territories, that's not an option for everyone seeking help, Maharaj said.
Health professionials emphasized it's important to help individuals with eating disorders as soon as they seek assistance for several reasons.
"We really want to catch people when they're reaching out, when they're probably most motivated and ready to receive care," said Trottier.
Ostolosky added the best treatment is in the first year or two of the person's illness because the neuroplasticity of the brain "is still there," meaning the brain can still be rewired to function differently, and for younger patients, the neural pathways that affect eating are still being developed.
"We're developing them back in the right direction by refeeding and that kind of thing. But the longer it goes on, the more entrenched and more difficult it is to come out of, which will necessitate longer hospitalizations later on. And so people waiting 18 months, well that's a long time to be sick, deteriorating," she said.
Access to publicly funded treatment for eating disorders varies across Canada and services diverge depending on if an individual is an adult or minor.
Number of publicly-funded eating disorder treatment spots per province by type, 2019
According to data collected by NEDIC in 2019, there were around 250 inpatient, day and residential spots in Canada, not including outpatient services.
Nunavut, New Brunswick, P.E.I., Northwest Territories and Yukon do not have any inpatient, day or residential options that are publicly funded, according to NEDIC's data.
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"When I think about the pillars of the Canada Health Act, I think I can really clearly say that we don't have equitable services for people experiencing eating disorders, and we don't have equitable mental health care coverage in Canada from a universal level," said Maharaj.
In addition to increased funding to offer more services, many of those working with people with eating disorders who spoke to CBC said access to care has to be improved.
Marlo Docherty, who lives in P.E.I., has been dealing with an eating disorder for over 30 years.
She has gone out of province to Ontario to get treatment, most recently from December until February of this year.
Although she said the treatment was "exceptional" and financed by P.E.I.'s government, it can be hard to come home to no publicly funded medical support.
"It's frustrating because it's like you go right back to old behaviours," she said.
"It's something we really should change."
Ostolosky said the quality of the treatment approaches in Canada could also be improved.
"What I see happening in eating disorder programs across Canada … is as soon as the person is referred and at a normal weight, they're sent out to a very limited day program," she said, adding people should be kept in acute care settings longer so they can be better supported.
A Health Canada spokesperson said in a lengthy statement that research into eating disorders and developing mental health standards are ongoing and that the federal government remains "committed to working with provinces, territories and other partners to promote access to high-quality mental health and substance use services for Canadians with a range of needs."
Maharaj said Canada's "patchwork" system for treatment is something that needs to be addressed. And although there are lengthy wait lists in some provinces, he emphasizes support is available in "some way, shape or form."
"I want them to still know that while things are broken, there are people trying to put things together and that's still some kind of warmth."
Support is available for people experiencing eating disorders.
People can call NEDIC's supportline at 1-866-633-4220 or use their live chat during business hours at nedic.ca.