New Thoughts for Eating Disorder Treatment Options: When the Healthcare System Fails

The last post reviewed the limitations imposed on eating disorder treatment and recovery by health insurance. Too many people leave treatment early and prematurely because of insurance limitations and decisions. The expense of full treatment can run very high as treatment lasts months or longer.

In the current health care climate, insurance will rarely cover adequate treatment for sustained recovery. But the problem just mutates in other health care systems. In a universal health care system, patients will receive full treatment but instead endure long waiting lists for care, also not an ideal situation.

What alternative treatment, likely outside the conventional health care system, could circumvent these issues and provide viable solutions for people in recovery from an eating disorder? Any option must include three basic components of treatment.

First is meal support. Recovery must in part focus on meals and snacks to re-train the mind and body to eat regularly again. The key here is support involving human connection and emotional support to get through each meal. Left alone to face the eating disorder, people in recovery quickly become demoralized and hopeless. 

Second is community. Eating disorders isolate people from friends and family. A significant part of recovery is learning how to engage with people and relationships again in an honest, real way. These connections reinforce life outside the illness and remind the person of the myriad reasons to eat each meal. The isolation gives more power to the eating disorder as a source of identity and as the only effective coping mechanism for life.

The third component is directed help to constantly question the eating disorder rules, beliefs and actions. In treatment, clinicians gently but directly shine a light on the destructiveness of the eating disorder. Without those constant reminders, it's too easy for the well-worn patterns of the illness to dominate the person's thoughts and actions and derail every valiant attempt to get well. The eating disorder beliefs become so ingrained that they feel like an absolute truth. A person in recovery needs help to always question these beliefs and not fall under the spell of the eating disorder again. 

Yet the standard treatment for people with eating disorders, outside of expensive programs, involves a number of appointments with clinicians per week and group therapy geared specifically to eating disorder patients. This arrangement provides elements of each of the three necessary components but with limitations. The person is left to navigate the treacherous road to recovery alone most of the time. The result is fending off the onslaught of eating disordered thoughts, struggling through each meal and continued painful isolation. 

The changes to daily living in the last decade seem tailor-made for eating disorder recovery. The ease of staying connected enables people in recovery to have real-time support and community at every turn and every meal. That support can come from clinicians and friends. In fact numerous studies have lauded text messaging as a tool for eating disorder recovery. A few clinicians have set up an online education systems with forums designed to provide support. Many treatments now involve email for anything from food journals to written therapy. Videochat services offer new alternatives for therapy sessions as well. 

However, the pro-anorexia and pro-bulimia websites are still more prevalent and more supportive than the online recovery options. Perhaps the drive for people with eating disorders to get support for their illness is stronger than the drive for clinicians or patients to create similar online forums.

I think it's time for clinicians and patients to join forces and create a portal online to offer the support people need to get well. If the treatment options and health insurance limitations in this country are not sufficient, then it's a duty of people dedicated to eating disorder treatment to create new avenues to help people stay in recovery. 

More about this in the next post.


Health Insurance in the Treatment of Eating Disorders: New Solutions for Recovery

Mental health care, already the stepchild of the medical establishment, will continue to have limited coverage in the new year when the Affordable Care Act begins to offer a marketplace for new insurance plans. In recent years, the media has covered the limited benefits and the financial hardship individuals with psychiatric illness and their families endure. Much of the blame in these stories lies with the lack of evidenced-based medicine in standard treatment, a fact insurance companies use to deny treatment every day. However, it doesn't seem right to penalize people whose illnesses have yet to be well understood. If the underlying problem is limited scientific understanding of brain function, shouldn't the system afford these patients equal care?

The newest leap into insuring all people with reasonable health care will continue the limited treatment for people with eating disorders as well. The scientific knowledge of these illnesses is extremely limited, more so than most psychiatric illnesses.

There are a handful of research studies supporting evidenced-based therapies but with only short-term limited results. Any experienced clinician knows that full recovery is a long process which involves a multi-disciplinary treatment team and often inpatient or outpatient treatment programs.

Over a period of months to years, effective treatment is expensive. Even the best insurance plans cover only part of the course of successful treatment, and most cover a fraction of the overall cost. Nowhere in the health insurance overhaul is there a provision for adequate long term treatment of mental illness, including eating disorders.

In the past, the stereotypical eating disorder patient was a wealthy Caucasian girl in her teens from a family with the means to pay for any available care. It's unclear whether this assumption was based in fact, but these illnesses no longer appear to discriminate by socioeconomic level or race. With the spread of eating disorders across all class lines in the United States and across the world, the reality of inadequate treatment options is unavoidable. Inquiries into my practice routinely come from patients and families aghast at the lack of resources in the community, especially those that accept health insurance. 

It is true that people with less means have significantly fewer treatment options. Based on knowledge of long term outcome of untreated people with eating disorders, the discrepancy in care between those with means and those without will lead to poorer outcome. Inequitable health care is a problem across all medical illnesses but there are no viable alternatives for eating disorder patients without the means to access treatment outside the health insurance plan.

These patients flock to two forms of help: free programs such as Overeaters Anonymous, a 12 step program akin to Alcoholics Anonymous, and the very limited options covered by insurance. Some people find a path to recovery this way, but many are left to soon give up hope and accept the eating disorder as a fact of life.

Advocacy for increased coverage for eating disorder treatment and for public education about these illnesses remains a mainstay of organizations such as AED and NEDA. They play a powerful national lobbying role to be sure the growing reach of eating disorders isn't ignored, but clinicians attempting to change the reality for individual sick patients and their families need more immediate options for treatment. 

I had hoped by starting this blog to reach more people with useful information and to create hope for those out of treatment options. Although that has indeed been the case for the people who have contacted me, the needs are just too great.

In the next few posts, I will try to explore new avenues for support and care of eating disorder patients outside the insurance bubble. The interconnectedness now a given in today's world hasn't changed eating disorder treatment enough yet. And if the health care system can't keep up, then other ideas need to fill the void.