When counsellor Samantha Durfy joined the University of Guelph’s department of student wellness in 2016, she was asked to take over the school’s Meal Support Group. Having specialized in eating disorders for 15 years, Ms. Durfy now co-leads the group with the department’s registered dietician, Lindzie O’Reilly, with the goal of helping students to manage whatever symptoms or feelings that come up while finishing a meal in their presence.

The overall mission of the group is to support participants in developing healthier relationships with food and to learn some life skills along the way. However, Ms. Durfy admits the experience can be intimidating for people who are already struggling with food consumption. “You literally have to bring your lunch and eat it,” she explains.

The group meets for about five weeks and each week they focus on a different aspect of dialectical behaviour therapy, which involves emotion regulation – a common issue that comes up around disordered eating. “We’re not doing treatment,” explains Ms. Durfy. “We’re certainly offering support, but when someone’s very unwell we are referring outside of the university.”

The prevalence of eating disorders

While data on the health of Canadian postsecondary students shows that many are struggling with mental health concerns like depression and anxiety, a small but notable segment of this population is specifically suffering from eating disorders, conditions that include anorexia, bulimia, binge eating, and highly restrictive or avoidant eating behaviours. Pauline Spiess of the Centre for Innovation in Campus Mental Health at the Canadian Mental Health Association says this could be “mostly due to stress, to changing environment – people going from home to campuses.”

A Canadian reference group (PDF) of the American College Health Association’s National College Health Assessment, released in spring 2016, found that two percent of students that year had reported that an eating disorder had affected their academic performance, compared to 32.5 percent reporting similar performance issues due to anxiety and 20.9 percent to depression. Based on surveys of 41 Canadian postsecondary institutions, the report revealed that a combined 2.6 percent of respondents said they had been diagnosed and treated for anorexia or bulimia within the previous year. That rate is much lower than the number of students who said they had been diagnosed and treated for anxiety (18.4 percent) and depression (14.7 percent) in that same period.

Accordingly, Ms. Spiess says she has seen less action on campuses around eating disorders and more around anxiety, depression and substance abuse. Still, a few institutions have committed to offering services that specifically address them.

On-site treatment and demand

One of these rare programs is housed at the University of Victoria. The Collaborative Eating Disorders Clinic, opened in February 2012, provides on-site treatment and support for various levels of disordered eating and refers externally for those who need additional help.

A partnership with B.C.’s Ministry of Children and Family Development and the Vancouver Island Health Authority, the clinic team includes a psychiatrist, dietician, psychologist and counsellors, plus a nurse and physician who provide client assessments. As with most services for students with eating disorders, the clinic focuses on prevention and early intervention, often in the form of group therapy.

(In a video posted on the Centre for Innovation in Campus Mental Health website, a second-year undergraduate student named Molly, who struggles with an eating disorder, praised support groups for allowing “individuals to connect so they don’t feel quite so alone.”)

Triaging care

McMaster University’s Student Wellness Centre treats eating disorders within a larger counselling network. It provides a consultation of 15 to 20 minutes to decide how the student should proceed through Pathways to Care, a triage system that progresses from self-help information all the way to crisis management involving hospital treatment. The centre, which receives about 12 drop-in appointments a day, is interdisciplinary, which means physicians, psychiatrists, nurses and counsellors work together. The mandate is to see everyone within a day or two, with severe issues commanding same-day response. “We want to lay eyes on everyone who says they need help,” says Debbie Nifakis, a psychologist and associate director of counselling at the centre.

Dr. Nifakis has offered an eating disorder support group at McMaster since 1991. The group is for anyone with issues around food or body image – approximately 55 percent of participants are female and 45 percent male – but most students prefer one-on-one care, with 60 percent of all students who come to the wellness centre requesting individual counselling. This includes students with eating disorders who have relapsed after a hospital visit, or who are on the list for the Eating Disorders Program at St. Joseph’s Healthcare in Hamilton, a wait that can exceed eight months.

“What we do is kind of just tide them over,” Dr. Nifakis says. She notes that the wellness team will continue to work with many students throughout their university career – Dr. Nifakis herself gets a number of repeat visitors in her office.

A cautionary tale

U of G’s Ms. Durfy took her inspiration from the Eating Disorder Program at McGill University. After eight years in operation, it closed permanently in September 2017. About 250 students attended the program each year, with 50 to 70 of those students engaged in intensive treatment with any number of clinicians on staff, including psychiatrists, psychologists, counsellors and nutritionists. “A lot of students were concerned about the amount of time that they had to dedicate to program because it did, or could, impact their studies,” says Martine Gauthier, executive director of student services at McGill.

In a three-year period leading up to the cancellation of the Eating Disorder Program, demand for mental health services at McGill soared by 57 percent, with 28 percent of students seeking treatment for depression and anxiety, and one to three percent for eating disorders. According to The McGill Tribune, in 2013, the Eating Disorder Program used 4.5 percent of the $11-million budget for student services, which is mostly funded through student fees. With rising student demand for services and limited resources, university administrators deemed it financially irresponsible to continue to focus on such a limited population. “Deciding how to use those resources in a way that met a majority of students was a major factor in [the cancellation],” says Ms. Gauthier.

Though the specialized program is gone, students with eating disorders can still get help from student services, which employs psychiatrists, nutritionists and counsellors. “We’re really looking at how do we mobilize our resources so that fewer students end up actually needing an [eating disorder] program,” says Ms. Gauthier. That includes collaboration and pairing internal supports with programs and services from community partners, an approach that will also keep graduates from relying on McGill’s services once they leave the school.

The situation at McGill illustrates perhaps the biggest challenge facing mental-health service providers on campus, including those who specialize in eating disorders: how to deal with increasing demand. “We’re always stretched,” says Ms. Gauthier, who adds that even though McGill increased the number of staff clinicians by almost 50 percent, they still can’t meet student need. Community outreach to local hospitals and programs with services for eating disorders appear to be the answer, right now anyway.

“Strengthening those relationships off campus … [is] really important,” says Ms. Spiess at the Centre for Innovation in Campus Mental Health. “That’s how they’re able to deal with the load of students seeking help.”