Robin Lauzon was just 10 years old when she was hospitalized with an eating disorder. It’s not something she talks about often, and she opens our conversation by apologizing for being emotional.
Shortly before Lauzon’s hospitalization for a deadly mental illness, her male family physician told her parents that her eating disorder was a common “phase” among young girls.
Living in rural Nova Scotia, Lauzon, now 22, said it was challenging for her and her family to access services and care.
“The closest location that we could be sent to was Halifax, and it was difficult not only to get a diagnosis, but also to be admitted,” she said in an interview. “Then once I was admitted, my family had to travel back and forth from Halifax after I left the hospital.”
After spending time hospitalized in Halifax, her family was offered an option. Lauzon could stay in the city or go home and be treated by family. Due to her young age, her parents didn’t want her to be alone in hospital so far from home for an extended period.
They decided to take care of her at home.
“Obviously that puts a lot of pressure on the family as well because you’re watching someone on bedrest for months on end,” Lauzon said. “It’s something that was a formative experience, that just showed me the difficulties that existed with the system.”
Rural disparities in health care
Even though 12 years have passed, that formative experience guides Lauzon’s current studies and her advocacy for better mental health care services for rural Nova Scotians.
Now a fourth year politics student at Acadia University, she’s in recovery and doing well. Lauzon’s preparing for next month’s presentation of her honours thesis, titled Understanding Nova Scotia’s New Virtual Care Policies: Mental Health Policy and Rural Nova Scotians. She expressed gratitude to her supervisor, Dr. Rachel Brickner.
“Something that I’ve focused on specifically is the lack of rural services and the barriers that rural people face accessing mental health care,” she said.
“Whether that be a lack of specialized services when we’re talking about virtual care, a lack of internet, financial issues, stigma within the community. Those are all contributors that create those rural disparities in health care.”
‘These difficulties still exist’
Lauzon said rural mental health services are lacking not only for eating disorders, but more generally. When she began her university studies, she was immediately drawn to public policy, health care, and related pandemic issues.
“I realized these access difficulties that I had witnessed firsthand still exist,” she said. “They still affect people today and have perhaps even been exacerbated by the pandemic. I wanted to explore that.”
Lauzon began working on her thesis last February. It included interviews with 16 different practitioners working in rural communities stretching from Cape Breton to Yarmouth. Those conversations included practitioners’ experiences with new policy changes and the shift to virtual care during the pandemic.
“There are so many difficulties accessing care, but the practitioners, I have the utmost respect for them. They’re amazing. They’re sacrificing so much of their lives for care. I wanted to speak to those practitioners because I have my lived experience, they also have their lived experience,” she said.
“I think going forward with new mental health care policies, it’s really important that their voices are heard. They have so much expertise and they can see how the policies play out in the real world. They can also maybe see the ways they’re (government) not totally addressing needs that perhaps they’ve not overlooked, but are unaware of.”
Urban solutions doesn’t always work rurally
Many practitioners stressed to Lauzon that for rural Nova Scotians, there are many “great benefits” associated with virtual care. It provides accessibility to a broader range of practitioners. It also alleviates travel and financial burdens as patients don’t have to worry about things like gas and other travel-related expenses.
Despite the benefits, they told Lauzon there are still challenges. Those range from internet access issues to the fact virtual programs are often “more generalized.” Another theme was the lack of specialized services for Indigenous and 2SLGBTQ+ populations.
Practitioners also stressed what is available for rural Nova Scotians needs to be better publicized.
“If we are moving forward with virtual care, a lot of the practitioners said awareness about virtual care is such a major need because there’s a lot of wonderful programs, but people might not necessarily know they exist or know where to access them,” she said.
In addition, practitioners expressed a need for alternatives to serve specific rural populations.
“Whether it be internet access, whether it be senior populations who are not familiar with or feel more comfortable accessing services in person,” Lauzon said. “In policymaking (there needs to be) contextual sensitivity and understanding that something may work in urban areas, but may not work in rural areas.”
Core funding for non-profits
Another issue identified by rural practitioners was wait times to access services. Those varied between four to eight months, a number Lauzon found “shocking.”
“I’m sure that that exists also in urban areas, but when you also consider that these small towns or communities are being served by only a handful of practitioners, it really intensifies the issue,” Lauzon said.
“Wait times are exacerbated in rural communities, and I think one of the good things about virtual care is you have access to a broader range of practitioners.”
Her research also found that many rural communities rely heavily on non-profit and mental health organizations. Because these organizations operate outside of the public system, Lauzon said core funding is crucial.
It was identified as a major need that would help ensure rural communities have access to consistent programs every year. This is largely because non-profits are providing many of the core services for those who may not need intensive, in-person treatment.
Lauzon said it only makes sense to provide those organizations with adequate and stable core funding.
“Nova Scotia has adopted a tiered care framework, and a lot of the services that are targeted…at the lower tiers of care are provided by non-profit organizations,” she said.
“I think that if we’re focusing or depending on those organizations, and they’re doing a lot of the legwork for the system, it’s really crucial that they have the support that they need.”
More rural training and internships needed
Earlier this month the province announced $37.4 million in funding for a new research institute at St. Francis Xavier University in Antigonish. The Institute for Innovation in Health will explore ways of improving health promotion and mental health and wellness in rural communities.
“The institute will offer education and training for current healthcare professionals, test and evaluate new ways of promoting health and wellness, and expand programs and virtual approaches to health education and promotion in rural communities,” noted a news release about the announcement.
Lauzon was thrilled by the news, calling the research institute “a crucial development” for the province.
“During interviews, several practitioners mentioned the limited availability of rural training and internships for mental health care professionals not only within Nova Scotia, but across Canada,” Lauzon said.
“Having a rural research institute in Nova Scotia will improve Nova Scotians’ access to health care professionals familiar with rural issues, increase our knowledge about rural-specific issues, and help create programs that are sensitive to the unique barriers rural Nova Scotians face.”
She hopes the institute will also consider conducting studies into virtual care and its impacts on rural health.
Op-ed about “fatally flawed” eating disorder care in Canada
Lauzon recently penned an op-ed for the Halifax Examiner. It can be found here and highlights the fact that women, especially young women, make up the majority of those seeking eating disorder care.
She wrote that for decades, eating disorders have been stereotyped as trivial, attention-seeking female behaviour.
“I experienced this first-hand when, at 10 years old, our male GP told my parents that my eating disorder was a common “phase” amongst young girls rather than a deadly mental illness, although I was hospitalized shortly after,” she wrote in her piece.
Lauzon said the number of people struggling with eating disorders skyrocketed during the pandemic. This fact makes it even more important to pursue solutions through a public policy lens.
“Across the spectrum, not only have issues increased, but also access has decreased or become more difficult because hospitals have had closures, services are becoming strained,” she said.
“So there’s that need for some sort of policy development, some sort of alternative, new solutions, that can help alleviate that new strain on the system.”
‘Don’t lose hope’
Despite the many challenges and struggles facing rural mental health practitioners, Lauzon’s optimism is unwavering. She said that stems from the fact that all 16 rural practitioners she interviewed knew the problems and had solutions.
“All of the people that I was interviewing had suggestions, they had issues they had identified, and things that they had done to try to work around. We have potential,” Lauzon said.
“We have people that are inspired, people that are working towards remediating the issues that exist. It’s just about trying to find a way to listen to these people and leverage all this expertise that we do have because we have amazing, hardworking practitioners that obviously know ways to help.”
Although she hasn’t yet confirmed her next steps, Lauzon will pursue either health law or a masters degree in political science or public administration. She’s determined to focus on health care and related policies. Her full thesis will be posted on Acadia University’s Scholar database sometime in May.
“There are services, there are programs, and there are people that are working really diligently to improve services,” Lauzon said. “So while the system is really overburdened, overworked, struggling, there are people who are working hard, practitioners, government officials, that are trying to help the situation. Don’t lose hope.”
A very brave young woman.