Staying the Course in Choppy Seas

Wednesday, Aug 23  •  


Benita Quakenbush
Owner / Founder / CEO

Eating disorders are a complicated, painful and potentially life threatening. Eating disorders have the highest mortality rate of all psychiatric disorders. (Crow, et al, 2009). One of the reasons I am so passionate about working with eating disorders is because I suffered and recovered from an eating disorder as a young woman. My heart goes out to anyone suffering from an eating disorder – I know the struggles and I want you to know full recovery and thriving in life is possible. I have passionately worked to build a center helps girls and women recover. I am grateful for a talented team that works tirelessly to help each client move towards sustainable success.

Treatment of severe eating disorders often requires residential treatment. The physical and therapeutic needs are more than an outpatient team can provide. Since the rollout of the Affordable Care Act, the field of mental health has changed drastically and I am ashamed and appalled at where the residential treatment market has gone.

Most treatment facilities originated with a desire to help those suffering from eating disorders and the founders had an altruistic focus on recovery and quality treatment. Nearly all of the US based programs are now owned by publicly traded corporations, private equity firms and venture capitalists. The founders are typically gone or have minority ownership and the focus has radically shifted from best practices for clients to shareholder profits. Much of the industry now treats to insurance coverage vs. treating to outcome. This has created a revolving door of treatment with clients cycling in and out of higher levels of care-often becoming more ill with each admission. Short stays and discharges when coverage runs out are the norm. Quality treatment is markedly absent much of the time.

It sickens me to think that there are companies run by private equity firms and venture capitalists who market heavily to recruit clients while knowing they won’t fight to keep them in treatment until the are ready to sustain recovery. They simply want to take advantage of the client’s insurance benefit for as long as it is offered. The New York Times recently wrote an article on some of the questionable marketing done by some programs and it can be viewed here. Recently, I’ve seen treatment program marketing emails that advertise short-term or finite summer treatment with a focus on school or college preparedness. “Visit us now for summer!” and “Get a quick tune up before school starts up!” I am saddened that a company can even imagine trivializing treatment of such a serious disorder as if someone suffering only needs an eating disorder summer camp. What’s worse is that many clients and parents are tantalized by these promises but aren’t aware that eating disorders treatment can’t be time-limited.

Due to the rapid expansion of treatment centers and lackluster results, insurance companies have tightened up their residential coverages and have begun denying coverage, approving only days at a time or refusing to cover anything longer than 21 – 30 days of treatment. For the clients I have met during my career, dismantling the eating disorder takes significantly longer than 21 days because the root causes are so multifactorial and require individualized care.

The American Psychiatric Association (APA) publishes standards of care for psychiatric treatment. These standards are basically a set of treatment guidelines that indicate the appropriate level of care based on symptom severity. Unfortunately, many insurance companies are denying the need to apply those minimum standards. You can view the treatment guidelines here. Table 8 features level of care guidelines based on 10 criteria. If a provider can’t/won’t treat to those standards, isn’t that malpractice? To draw a comparison, if an insurance company only allowed for ½ of a cancer tumor to be surgically removed and the provider complied, wouldn’t that be malpractice?

Overall, the client and their families are truly the ones who suffer in this environment.

At Avalon Hills, we not only continue to Treat to Outcome, we strive every day to improve treatment interventions and advocate for our clients to receive the highest quality care they need and deserve. We have also spent nearly three years implementing applied neuroscience and more intensive individual and family psychotherapies into our treatment program. With a robust focus on traditional therapies, experiential therapies, sensorimotor and mindfulness interventions like equine therapy, yoga and martial arts, we have now also added interventions based on each individual’s qEEG (brain map) to facilitate increased brain-based change.

I know that Avalon Hills stands alone as the only privately owned, founder led residential eating disorder program that treats to outcome (not insurance benefit) in the United States. We have over 100 employees who dedicate their work lives to give each client every possible chance at success. You have my personal guarantee that if you or a loved one needs residential treatment, Avalon Hills will give compassionate care and that you will gain a strong advocate for your recovery. We know in our core that sustainable success is possible!

ReferencesCrow, S. J., Peterson, C. B., Swanson, S. A., et al. (2009). Increased Mortality in Bulimia Nervosa and Other Eating Disorders. American Journal of Psychiatry, 166 (12), 1342-1346.