Our numbers are small, so maybe that’s one reason we’re so easy to silence. The lifetime prevalence of anorexia, in the general population, is 1 percent of women, and of that 1 percent, about 40 percent will recover within five years, and an additional 40 percent will achieve partial recovery. So while, as I will continue to demonstrate below, adult women with long-term anorexia are often being routinely subjected to forced treatment which decreases rather than increases our chances of recovery and at times rises, I believe, to the level of abuse and malpractice –we are tiny in number and stature, and thus hard to hear among the clamor of apparently more-pressing issues in mental health policy today.
And the most extreme of us look ghastly on top of it – only further reinforcing the incorrect perception that we’re literally out of our minds, one of the many widespread misconceptions about adult women battling severe and enduring anorexia (SE-AN)* which proliferate today. (Many women with severe, long-term anorexia are also not severely emaciated, per DSM standards, but struggle significantly nonetheless).
This article in my series will continue my attempt to shed awareness about how the eating disorder (ED) field’s continued institutionalization of women battling long-term eating disorders – particularly anorexia – is hurting more than helping, by taking a closer look at the lack of data supporting residential treatment’s efficacy, the wide disparity in licensing standards and enforcement nationwide, and the issues surrounding accreditation.
In an era of health care reform where more efficient spending of health care dollars, outcome-oriented accountability, is being stressed, it seems that examining what is looking more and more like a flagrantly wasteful use of insurance companies’ as well as families’ money is long over-due.
Particularly when you consider that, globally, we are spending more on inpatient treatment for individuals with SE-AN than we are for schizophrenia[i].
As noted in “Part 1” of this series, eating disorder treatment is a an estimated $3 billion industry, according to the most recent IBISWorld market report[ii]. Due to growing demand, industry revenue is expected to annually increase at – a minimum – a robust rate of 5 percent. The profit potential of the ED treatment industry is so ripe that nearly the entire market has been bought up by behavioral healthcare networks or investment firms. Acadia Healthcare, one of the largest behavioral healthcare conglomerates in the nation (following its purchase of CRC Health Group last year), owns many of the nation’s most prominent ED centers, including Timberline Knolls (Illinois), Sierra Tucson (Arizona), McCallum Place (St. Louis and Austin, TX), Montecatini (Carlsbad, CA) and Center for Hope of the Sierras (Reno).
The industry buy-out can work for good or bad, said Deanna James, director of marketing for Castlewood Treatment Center. While the influx of money can help improve programs, conglomerate ownership has the potential to hurt centers when industry giants purchase too much at once and impose standardized, cookie-cutter approaches on programs for efficiency and economics’ sake.
“It’s very hush-hush – treatment centers don’t want to be [publicly] branded as being owned by these conglomerates,” James said. “I do think it definitely plays a role in the quality of care.”
Castlewood – as well as the Eating Recovery Center in Denver – was itself bought up by a smaller, private equity firm, Trinity Hunt Partners, a few years ago. James said Trinity has not forced Castlewood to cut corners or compromise the center’s flexibility in the range of tailored treatment it offers clients, nor the center’s commitment to using empirically-supported practices. She believes the center has only benefited from its ownership.
[Disclosure: Castlewood Treatment Center is one of the many programs I’ve attended; I was a client there before it was bought by Trinity Hunt Partners, and before Castlewood obtained the quality-control accreditations which will be discussed below].
United Health Services, another huge behavioral healthcare network whose ED centers include River Oaks Hospital (New Orleans) and the Center for Change (Utah), is currently being investigated by the federal department of Health and Human Services for allegations of fraud and neglect that have endangered the welfare of patients. The investigation was spurred by a series of articles by two major newspapers, finding negligence, “cutting corners,” staffing failures and patient deaths across Arbour Health System facilities in Massachusetts, and violence and sexual assault, among other things, at some other, Midwest[iii]. United Health Services’ corporate office has also been under investigation for fraudulent Medicare and Medicaid billing.
But Jillian Lampert, a leader in the field and chief strategy officer of the Emily Program, whose levels of care include the Anna Westin House, hasn’t seen investment firm buy-out impact the quality of eating disorder treatment.
“I know that it’s a concern, but I think those [entities] are investing because they see some eating disorder programs as providing really high quality of care,” said Lampert, whose center remains privately owned and has not been purchased by any such company.
It’s impossible to know what, if any, impact this industry trend has actually had, because for-profit ED programs are, for the most part, not tracking clients’ long-term outcomes – leaving consumers with no impartial measuring stick by which to judge whether a program is effectively treating clients or not. The Emily Program is an exception, being the only private program I know, of to date, to have completed a 2 ½ year outcome study – including a control group – that will be published in the coming months. That study, and the state of outcome research in general, will be discussed in depth in “Part 3” of this series.
Despite the paucity of such research, however, insurance coverage of residential treatment continues to expand. National awareness campaigns by eating disorder “advocacy” groups – some of whose primary funding base is the for-profit, treatment industry – are constant, and insurance parity legislation, as a result, on the rise. Recently, the state of Missouri expanded insurance coverage for all levels of treatment, including residential, despite its unproven efficacy. If the federal government passes the recently-introduced Anna Westin Act this year, insurance providers in every state will be required to cover all residential, eating disorder treatment centers, regardless of the quality or efficacy of the treatment that center provides – a huge boon to the industry. While expanded coverage of eating disorder treatment is certainly a positive, it is essential consumers demand this legislative mandate come with strings attached: greater transparency and oversight of programs which now operate with minimal regulation and virtually no accountability. That the federal government allocate more of its medical research funds toward eating disorders, to help enable program outcome studies, is essential, too.
*The “SE-AN” diagnosis is generally used for individuals who’ve battled anorexia for seven or more years, have experienced multiple treatment failures, and have poor quality of life, among other variables.