Residential Eating Disorder Programs are a Part of the problem in Recovery

The expansion of residential treatment for eating disorders in the last decade transformed the scope and clinical decision making for these patients. The number of programs increased by multiples. Many more patients go to programs than in the past.

It’s questionable whether the steep increase in residential treatment was warranted.

The driving force to expand treatment was financial. Private equity interests supported the expansive growth in programs and transformed access to higher levels of care. Large sums of health insurance money was a clear incentive. Substance abuse treatment provided a model for easy access to insurance dollars that could turn a profit. The quality or even need for so much treatment does not seem to be the top priority.

I had written in this blog about the need for more access to care for years prior to the treatment program boom, but I never could have predicted the capitalist forces that might take over. The number of programs, often staffed by minimally trained clinicians, is not based on need but instead on greed.

At this point, outpatient eating disorder treatment increasingly relies heavily on access to, and the threat of, institutionalization much more than in the past. It’s too easy to ship off patients not making much progress in recovery without any thought about the repercussions of residential care.

The myriad concerns about forcing adolescents and young adults into eating disorder treatment loom large. The flaws and potential abuses in the system are treacherous and damaging. The risk of derailing these young people on their life trajectory is high. Access to more programs isn’t always the answer, and, in fact, there is little substantiated data that supports residential treatment as a means for success. More thought must be given to the pros and cons of treatment programs for young people in an individual basis.

Clinicians can provide the semblance of adequate care by threatening the patient with a program if outpatient treatment does not “work.” However, eating disorder treatment is notoriously challenging. One must expect ups and downs and not resort to drastic alternatives just because progress is slow or uneven. Referrals to higher level of care must be used judiciously and thoughtfully.

Sending a patient off the typical road of their peers has inherent risks. It’s much harder for them, even after one program, to return to the same path as those around them. They struggle to explain how and why they went to treatment. Although some can overcome this new hurdle, many see themselves as defective or unable to progress in their life. The eating disorder becomes too central after devoting months to a treatment program. The separation from typical life itself becomes an obstacle, if not damaging, for many people.

Why have clinicians not taken the helm of treatment decisions for people with eating disorders? The sad truth is that many of the esteemed providers have collaborated with the finance industry-based initiatives to create the glut of programs. The eating disorder treatment community is not coherent enough to resist the influx of this kind of money. Capitalism has power in the medical field to stop even clinicians from doing the right thing.

The path forward clearly includes access to programs. However, treatment providers need to stop being lured by financial gain and the ease of shipping people off to treatment and instead focus on the hard work of helping people recover from their eating disorder.