Youth eating disorders appear to be on the rise in N.L. The result? A big backlog to treatment

A sustained rise in eating disorder referrals among youth in Newfoundland and Labrador has swamped Eastern Health'swait list for services, with no end to the backlog in sight.

Around July 2020, a few months after the COVID-19 pandemic hit, referrals to the pediatric eating disorder programatthe Janeway Children's Health and Rehabilitation CentreinSt. John's started to surge.

The numbers nearly doubled, reachingaround10 per month, month after month,causing the wait for youths to be seen to stretch from the formerthree-month averageto well over a year, according to a doctor in the unit.

"It was really an exponential increase,and we've been unable to keep up with the referral numbers," said Dr. Anna Dominic, an adolescent medicine pediatrician.

Dominic and the other members of her team see patients from across the province, as Eastern Health handles referrals from the other health authorities for both the Janeway and its adult counterpart program based in the Health Sciences Centre.

Eating disorders are complex; while they centre on food, the cluster of mental illnesses that include anorexia and bulimiainvolve a variety of factors, such as anxiety and low self-esteem. That complexity requires time to treat, said Dominic, with patients often in the system for six years or more.

"It's not an acute illness that gets better very quickly," she said.

There are now about 40 children under the age of 18 waiting to be seen, according to Eastern Health.

"We can't really discharge people prematurely before they're ready. It's kind of like when you're pouring water into an already full cup. There's no room for it to go," she said.

That overflow effect is rippling thoughthe main support network in Newfoundland and Labrador for families of those dealing with eating disorders.

"It's veryconcerning," said Paul Thomey, executive director of the Eating Disorder Foundation of Newfoundland and Labrador.

"We hear it from families, and as a result, our contacts with families have probably increased,becausethey're now looking to us for support in that period while they're waiting."

The foundation hashad a near doubling of participants for some of its programs in 2021, he said, and the number of people simply calling to seek help has also risen dramatically.

The story behind the surge

By now, it's a well-known story: the arrival of COVID-19 in March 2020 utterly upended public life in the province.

As Dominic watchedthe array of supports teenagers rely on for structure from school to extracurricularsto simply hanging out with friends stripped away and replaced with isolation and anxiety,she saw the troubling potential for eating disorders to rise.

"Idefinitely suspected that was going to happen," she said.

"Ifelt that mental health was going to be the big, significant event with outcomes for adolescents,and Ithink we've certainly seen that in our practice."

Dominicis part of a cross-Canada group studying the connections between youth, eating disorders and COVID-19, but there's a growing amount of scientific research emerging internationally that supports the idea that the disruption to daily life has not only increased risk factors for eating disorders, but increased barriers to getting help.

While rising vaccination rates have buoyed the prospect of a return to near normal,the foundation remains skeptical that the backlog of youths needing treatment will lessen any time soon.

"Idon't see anything easing up. Iguess the near-crisis in health care with waiting lists is going to mean continued need for support from our organization," said Thomey.

The foundation's ability to support families increased, Thomey said, when it moved all its programs to the virtual world due to the pandemic. The programs, previously available only in the St. John's area, are now attended by families across the province, with some calling from the Maritimes and as far away as Scotland as people seek help anywhere they can find it.

"It's created a whole new environment and a whole new way ofdoing things, and much broader audience for us to reach out to," he said.

'A very difficult challenge'

Anotherreason for Thomey's skepticism over the wait-list backlogeasingboils down to staffing.

As referrals have risen, the staff to treat the patients has stayed the same, said Dominic, who is one of a team of five.

"It's just a very difficult balance right now, without having enough human resources and space to do what we need to do," said Dominic.

In the meantime, the staff who are there are working hard to see patients in need, and Dominic said anyone urgently needing care is getting it, although that may be taking place in the emergency room or at a family physician's office.

"It's challenging. And it stresses me out to have such a wait-list," she said.

"Ithink that's one of the things that Ipersonally find most difficult,is Inever like to have patients waiting very long."

According to Eastern Health's job board, there are also two vacant psychologist positions with the adult eating disorder unit still waiting to be filled. In an email, a spokesperson for Eastern Health said it was recruiting for one position and using a social worker on a temporary basis to fill in, in the meantime.

The foundation has pressed Eastern Health for more resources for both adults and children, said Thomey,to no avail.

"We've been asking for additional positions, and we're kind of getting told, especially in the area of psychologists, that you'll be lucky if we're able to fill the current positions, let alone the additional ones we need."

Dominic also doesn't see more staff on the horizon.

"It would be nice to have more resources, but Iknow given the economic situation that we're in, that's probably not going to happen."

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