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.