A recent New York Times article pointed out changes in the eating disorder residential treatment industry that have caused significant changes to the programs. I still recommend residential treatment for many patients, but it's important to realize that these are not hospitals but have been bought by for-profit businesses with several, often contradictory, motives. Programs originally started by passionate individuals are now owned by holding corporations which have an influence on overall treatment. The educated patient needs to weigh all these factors into the decision to seek residential care.
Originally, treatment programs were all based in hospitals. They sprung from psychiatry programs in larger academic centers through the 1980's and 1990's when the need for eating disorder treatment followed the skyrocketing incidence of these illnesses. Although these programs still exist, changes in health insurance coverage have shortened hospital stays to only a few weeks and limited the hospital-based programs to provide primarily medical stabilization. Few still include long term treatment that can lead to recovery. Most hospital programs will refer recently stabilized patients to residential centers.
About 20 years ago, driven individuals started to create independent residential treatment facilities. Many of the founders were in recovery from an eating disorder themselves. They sought to provide a caring, kind and hopeful environment--qualities that much of the literature suggests are crucial to successful treatment. The growth of these centers stems from the extremely low success rate of outpatient treatment and hospital-based programs.
Because there is so little treatment proven to be effective in eating disorder recovery, the residential programs focused on creating an experience that reflects the knowledge of very experienced clinicians, a novel idea at the time. The notion that programs need to focus on evidence-based treatment is not viable: if treatment were that effective, there wouldn't be a need for residential centers. Evidence-based treatment typically reduces symptoms at best, but many programs strive instead for full recovery.
A number of programs have successfully managed and treated a large number of patients, often some of the sickest and chronic ones. Integrating people into a community of recovered individuals who can provide ongoing care and support, seemingly crossing standard boundaries in psychotherapy, has been remarkably effective for many patients.
As for-profit businesses, the residential centers are also of interest to financial firms looking for a profit, and this problem has become a new and concerning issue in the industry.
Over the last few years, financial firms bought some of the most well-established and successful programs and, eager to expand the company for eventual sale, have opened many new branches across the country very quickly over the last few years. But expanding an eating disorder program is very different from opening more franchises of supermarkets or clothing stores. Replication of a successful treatment center is a more complex endeavor that involves hiring and training the right staff and incorporating a complex treatment philosophy.
The new programs are very uneven in staffing and therapeutic approach. It has proven extremely difficult to create the support and commitment of a treatment center to other branches opened across the country. The need to increase profitability, not for patients' benefit but for the financial backers, has compromised the quality and compassion of residential care. Accordingly, patients must beware of which program they choose to enter and need to educate themselves on each branch's reputation.
On a final note, the newspaper article doesn't acknowledge the long-term benefit of residential treatment to the eating disorder community. These programs have offered hope and recovery to people otherwise condemned to chronic, debilitating illnesses. The committed clinicians and administrative staffs have created an environment of healing unparalleled in the eating disorder treatment world.
The problem lies with introducing for-profit financial companies into the mix. That combination doesn't benefit patients at all.