Canadian eating disorder patients are being denied treatment due to the chronicity of their condition. An eating disorder treatment program, at St. Paul’s Hospital in Vancouver, has discharged at least a dozen patients with dangerously failing health conditions, because their illnesses have been labeled chronic cases. Although the program claims to have very stringent and evidence-based criteria for denying treatment, their website offers no helpful information on criteria for admissions or denials. St. Paul’s says, “The program is engaged in innovative research in the field of eating disorders and provides knowledge translation, education, consultation, and outreach activities to support a network of eating disorder services for adults across the province. “http://www.providencehealthcare.org/info_services_health_mhealth.html
If this program was truly involved in innovative research, and dedicated to outreach and support, they would recognize that recovery is possible, despite the possibility of relapse. Discharging patients in such dire health leaves them with little chance for recovery and survival. Although patients have the potential to relapse, treatment is cost effective for eating disorders. Patients with anorexia nervosa who reached 98% of Ideal Body Weight (IBW) prior to discharge from inpatient are less likely to relapse than those who only achieved 83% IBW. (Program completion = abstinence from bingeing and purging and maintaining weight for 2 weeks.) Halmi and Licino (1989). Shorter periods of treatment for eating disorders are associated with less successful outcomes.
An important component to consider when denying coverage for treatment is that recovery takes place over a long period of time. Strober, Freeman, Morrell (1997) reported that 76% of a sample studied for 10-15 years after admission met criteria for full recovery, but time to recovery ranged from 57-74 months; 10% met criteria for partial recovery. Even successful treatment for eating disorders has been known to have an uneven course, declining two years after intensive in patient treatment, then stabilizing and improving again.
Two months ago, when patient Amber Foster was discharged and denied further treatment from St. Paul’s, at only 80 lbs, the message was clear that her “chronic disease” did not merit her additional treatment and resources to help her improve the quality of her life and continue her recovery. Foster is currently at home, where she has lost 4 more pounds, and struggles from refeeding syndrome. Foster was told, “You have a chronic lifelong disease that you’re just going to have to learn to live with. There’s nothing else you can really do. “
With all the information that we know about treating eating disorders, this reasoning is outrageous and literally leaves Foster to deteriorate at home. The program’s head of psychiatry, Dr. Maria Corral, feigns distress as she denies systematically sending older chronic patients home. She declares, “We are all concerned when we hear that our patients are suffering.” Unfortunately, concern for patient’s health doesn’t help nearly as much as treatment. Corral continues to imply that the comorbidity that occurs with eating disorders fluctuates over time, which makes treating these patients very complex. Perhaps she means expensive.
“I feel like I’m being sent home to die” – Amber Foster
CBC News reports that this is British Columbia’s only eating disorder treatment program for adults, and if they are comfortable “sending them home to die”, then these patients need to be sent to other facilities that can properly help them.