A How To Guide For Advocacy & Eating Disorders - The Basics

This piece is shared from one of our founding members personal blog, but pertains to the recent service cuts at the South Island Eating Disorder Program. For the original piece, click here.

Step one, have a wealth of in depth knowledge of the provincial government, an understanding of service distribution through different ministries, and a network of insider connections.

Step two, have in depth knowledge of the healthcare system, an understanding of healthcare costs and priorities, and a network of insider connections.

Step three, have a business degree level of social media marketing skills.

Step four, develop an unofficial expert level of journalistic ability to sleuth out information.

Step five, have the equivalent of years worth of government communications work.

Or at least, this is how it feels much of the time, but it should not be this hard. Meaningful advocacy should be accessible to everyone. I am conscious that the privilege I occupy has allowed me to be fairly well-versed in understanding some of the pieces that underlie my own advocacy work. Still, there's more that I don't know and I would call myself an absolute novice in this realm. I'm certainly not going to be able to explore all the moving parts of advocating for eating disorders within a single blog post (nor would anyone want to read something so dry in one sitting), but I can try to share what I know and learn from others who know more. In response to the worsening state of eating disorder services for adults in B.C., I think it's critical to examine how the structure of systems in our province makes creating change through advocacy so challenging.

In the end, this topic is really about making advocacy more accessible to those who most need the change that can result from it. Let's start with understanding a little bit more about the role of government and provincial ministries in the provision of services. Essentially where does money come from and who does what? This topic is a bit dry, but I appreciate you trying to bear with me.

Understanding the Government's Different Roles in ED Services

Healthcare funding comes from two sources - the federal government and from within each province itself. Other aspects of healthcare (e.g. public health, which includes sanitation and so on) is also under municipal responsibility. While certain mandates are passed at a federal and provincial level on how to spend some of the money, much of how a province's government distributes funding is up to them. Each provincial government looks a little bit different in its composition; in B.C. there are three main ministries that we need to discuss when it comes to talking about who does what for eating disorders and mental health:

  1. The Ministry of Health (MoH)

  2. The Ministry of Child and Family Development (MCFD)

  3. The Ministry of Mental Health and Addictions (MoMHA)

This graphic is a simplification and there may be details beyond my awareness, but it gives a basic picture of who does what when it comes to services for adults with eating disorders in my community of Victoria, B.C.

In all other areas of the province, services are offered through local health authorities (which would be under the MoH). However, in the South Island region, adult outpatient eating disorder services are offered through the Ministry of Child and Family Development (MCFD).

Let's take a brief look at each ministry's responsibilities in relation to ED services in B.C.

The Ministry of Health

  • Responsible for funding aspects of eating disorder and other mental health services across the province, via regional and provincial health authorities (on Vancouver Island, this is Island Health). For example, the MoH is responsible for the 2 local inpatient beds for EDs in Victoria and the provincial services for eating disorders offered through Providence Healthcare/St. Paul's Hospital.

  • Provide mandate letters outlining priorities to provincial, regional, and local service providers.

  • Collaborate with other ministries to provide eating disorder and other mental health services (i.e. MCFD)

The Ministry of Mental Health and Addictions

  • Work in collaboration with other government sectors (i.e. MoH)

  • Responsible for cross-sector planning, research, policy development, and evaluation.

  • No direct funding for mental health and addiction services (but they can lobby for these issues)

  • Focused on general mental health and addiction services.

The Ministry of Child and Family Development

  • Responsible for child and youth care, protection, support needs, and mental health.

  • Work in conjunction with the MoH to provide youth and adult outpatient eating disorder services in certain locations around the province (e.g. Victoria, Prince George, Kelowna).

Why the set up is this way, is not clear to me (or to the government itself as there often seems to be little understanding of who does what and why, at least from my observation.)

What are the key take-aways from this confusing set-up?

  • Multiple ministries are involved in providing eating disorder services for youth and adults, but it is not as readily apparent who is responsible for what as common sense might deem.

  • The MoMHA has no direct involvement with the provision of eating disorder or mental health services.

  • Adult outpatient eating disorder services (in Victoria, B.C. and some other locations around the province) are offered through a ministry whose focus is on youth (and whose mandate will always require them to prioritize youth.)

If you're confused about how this all works, it means you're paying attention. It's this muddle of things that makes advocating for adults with eating disorders in B.C. so difficult (alongside other factors such as stigma, lack of awareness, stereotypes, etc.)

The question that comes from all of this - how does split responsibility between ministries, support eating disorder services and how might it compromise accountability, efficacy, adequacy, and fairness across the province?

If adult outpatient services are always alongside youth services in a ministry whose focus is on the latter, adults will always lose out: it's not a battle we can win nor should it be framed as such. These are two different patient populations with very different needs. It's critical that there are supports out there helping families get access to treatment early (that was my family when I first became ill and I won't be the first to say that there wasn't enough support.) But adults deserve support in their own right, not as an afterthought.

Upstream interventions don't stop at age 18. Upstream approaches to supporting people can and should occur for patients at any age, which is why community supports are so critical. Adults are not lost causes (though I know I am sadly not alone in being told I would be a "chronic" patient even when I was in my early twenties.) Adults are valuable in different ways. We are participating members of society, we contribute in ways that youth are not yet able to. We are often more capable of doing work and digging deep into the roots of our struggles as we gain some insight and experience that only time can offer. I know for myself, I had no insight into what an eating disorder was when I first became ill. It wasn't until I had aged out of the system that I had enough motivation and self-awareness to truly engage in recovery work that focused on healing my mind, not just restoring my physical health. By then, my options were limited and my heart goes out to every person and family going through the aging-out process. It occurs in two small deaths, at 18 and again at age 24/25, when you cross a line where there's a sharp decrease in what's available for support.

For anyone facing this, I want you to know (to carry with you in the darkest moments) that the limitations in what supports there are, are not a reflection of you or what you are capable of in recovery. You carry capacity within you always and I am so sorry if the system has made you feel otherwise. You are not a lost cause no matter how many times you come back to trying to heal. It doesn't matter if you're 26 or 62, you deserve the resources to explore your healing and you have new things to offer to this process each time you engage with it. This road is hard and though our journeys are different, you are not alone. I am so sorry that you have to fight so hard to get help when you are already facing so much. It should not be this way. People deserve better and I believe we're capable.

That's what I come back to when I feel so frustrated that I don't know where to put my anger and grief. I have to turn it over and over in my hands until the roughest edges are smoothed out and I can proceed with passion that isn't marred by defeat. But now I am rambling and this post will be heavy enough for people to try and sort through. I promise not all posts will be this thick with confusion, but it's also that very feeling that I want to leave you with (and want to impress upon government and healthcare) because that is the essence of trying to create change for adults with eating disorders in B.C. It's hard to know where you even start, and there's no perfect formula to it, you just start and try and try again.

There will be much more to share on how things work (as my limited understanding can describe) and there will be more to share on other things too. But this is where my thoughts are today, thick with the urgency of craving change and the stubbornness to ensure we hold ourselves accountable as a province to creating it. We're more than capable.

- S.

References

Shaely Ritcheyadvocacy, eating disorders, recoveryComment