Reprinted from "Eating Disorders" issue of Visions Journal, 2002, No. 16, p. 34-35
The following excerpts are part of interviews conducted with the tertiary eating disorders clinics in Vancouver. At St. Paul’s Hospital Eating Disorder Clinic, I interviewed Dr. Laird Birmingham and Linda Lauritzen; at Vista, a program developed in collaboration with St. Paul’s, I talked to Tracey Dobney. Ron Manley met with me at BC Children’s Hospital Eating Disorders Program.
What services do you offer?
St. Paul’s: We are the provincial adult eating disorder program so if there are tertiary type problems [more serious] throughout the province, they are referred to us. Clinical services consist of assessment (psychosocial and medical), the Community Outreach Partnership Program (COPP), the Patient/Family/Friends Psychoeducational Group, Outpatient follow-up, the Short Stay Program (Extra Care Program), the Day Treatment and Residential Program (Vista), Quest and the Long Stay Program. So we have both inpatient and outpatient services; as well, we are active in research and education for the whole province.
Vista: We are a three to four month intensive residential program for men and women with eating disorders. We have a total of 10 beds in our program — eight of those beds are allocated for people who are going into the Discovery Program at St. Paul’s (i.e., the Day Treatment program). Two of our beds are support beds available for people prior to going into the day program at the hospital, and following treatment as a transitional space.
BC Children’s: This program has been in existence for approximately 20 years and the programs have several different components: there is an inpatient program for people that are medically unstable, there is quite a large outpatient program, a day treatment program, and a residential component.
What is the underlying philosophy of the program?
St. Paul’s: Our primar y responsibility as far as the government is concerned is to make sure that those people that are the sickest receive good treatment. The other part of our philosophy is to try to help develop those treatment facilities or treatment modalities throughout the province; this includes looking into treatments and giving advice about what treatments might be of use throughout BC.
Vista: We come from a psychosocial rehab perspective, so what we are looking at in this part of the program is all aspects of the client’s life in terms of their psychological and interpersonal skills. We really look at an eating disorder as a coping mechanism; what we see is that you cannot take away that coping mechanism without replacing it with other things that are not going to be so destructive, and therefore take away from quality of life for people.
BC Children’s: Our philosophy is certainly multidisciplinary, so there is a very strong emphasis on the team approach and an understanding of the eating disorder in a much larger context, a biopsychosociospiritual model of care.
Have you seen any shift in your demographics or diagnostic trends?
St. Paul’s: We are seeing more and more very ill (people); we used to years ago be able to see people from throughout the province sometimes with mild eating disorders. A very important change, which is a very positive one, is that we now can treat people that need long-term inpatient care here at St. Paul’s instead of sending them out of province, which costs more money. We have noticed that one of the biggest shifts over the last 10-15 years is that there is quite a different approach in offering treatment to people with eating disorders. In the past, people were often brought into hospitals and treated against their will and treated for longer periods of time under certification. Now there is a much more healthier respect for the patient, where they are at, so what we have found and what the literature supports is that it is not helpful to offer aggressive treatment to someone who is not ready or willing to look at making changes. Now there is more of an emphasis on helping people to get to a place of wanting to make changes.
Vista: The people we are seeing are actually at a higher body weight than when we started 7 or 8 years ago . They were more undernourished in prior years, we used to take people at 10% body fat and now the minimum is 16%, because for them to do the intense work they need to do, they need to be able to think and at a lower body fat percentage they are starving and just can’t function.
BC Children’s: I would say that our demographics are pretty much the same; because of our mandate here we have always seen people who are pretty ill. One thing that has shifted is that our census used to go down in the summertime to some degree, but in the last few years the number of referrals has really increased.
What do you see as the most pressing issue in the area of treatment for disordered eating? What would you like to see change?
St. Paul’s: We need a larger population of family doctors throughout the province that would help us treat eating disorder patients. Because not all doctors are familiar or even comfortable with eating disorders, they perhaps do not receive enough time or backup to help people with eating disorders where they live. The next thing that is needed is a much larger group of psychiatrists throughout the province. At the moment there are very few psychiatrists that would say that they are experts in treating eating disorder patients. Finally, in the logical sense, we need to have hospitals commit to admit patients with eating disorders, because even hospitals throughout the province are quite often confused or uneducated or not aware or perhaps not motivated — for whatever reason they will not accept patients with eating disorders.
Vista: I see the need for there to be more work done around the issues of eating disorders and alcohol and drug addiction, specifically the catch 22 that people are in. Generally they cannot get service for the alcohol and drug issues if they have an eating disorder and cannot get treatment for the eating disorder unless they are first treated for the alcohol and drug issues.
BC Children’s: There are so many that it is hard to put your finger on just a few. Given that we can’t do everything, how best can we meet our mandate in the best way possible? I think that there needs to be more education and research done across the province about eating disorders, especially with children and adolescents, because we need the developmental aspects met. There are different considerations with this population and there is not much written on it — instead they scale down what is written for adults.