Their websites show peaceful scenes — young women relaxing by the ocean or caring for horses in emerald pastures — and boast of their chefs and other amenities.
One center sends out invitations to a reception with cocktails and hors d’oeuvres. Another offers doctors and therapists all-expense-paid trips to visit and experience their offerings, including yoga classes. Several employ staff who call mental health professionals, saying they would love to have lunch.The marketing efforts by these for-profit residential care centers are aimed at patients with eating disorders and the clinicians who treat them. The programs have proliferated in recent years, with some companies expanding across the country.
The rapid growth of the industry — there are more than 75 centers, compared with 22 a decade ago, according to one count — has been propelled by the Affordable Care Act and other changes in health insurance laws that have increased coverage for mental disorders, as well as by investments from private equity firms.
Eating disorders are among the most difficult mental illnesses to treat.Anorexia, in particular, has stymied many of psychiatry’s best treatment efforts. The illness has the highest mortality rate of any mental disorder, with patients dying from the medical complications of starvation or from suicide. And patients often resist treatments that make them feel uncomfortable.The most severely ill patients — the prognosis is grimmer the longer someone has anorexia, studies suggest — require hospital treatment just to stay alive. But even after being stabilized, many patients need continual supervision for a time to regain weight and learn new behavior. The length of stay in residential centers ranges from two weeks to a year. A 2006 study found that the average stay was 83 days.In the past, health insurance companies placed strict limits on coverage for eating disorders, treating them differently from other medical illnesses. Few insurers were willing to pay for 24-hour care after a patient was out of immediate danger.But the passage of the Mental Health Parity and Addiction Equity Act in 2008 and the Affordable Care Act two years later mandated equal treatment. Lawsuits brought by the families of patients who were denied coverage added to the pressure on insurers. In 2012, a federal appeals court ruled that health plans must cover residential treatment for anorexia under California’s parity law. The higher reimbursement rates offered some relief to families, who had often mortgaged their houses or drained their savings to pay for critically needed care.alcoholism and drug abuse. “The number of covered lives is growing faster than the availability of services to treat them, creating compelling investment opportunities,” the accounting and consulting firm BDO noted last year in an article on its website, referring to the effects of the legal changes.They also attracted the attention of Wall Street investors, who saw profits in providing treatment for so-called behavioral health problems like eating disorders,
Melissa R., 28, who asked that her last name not be used for reasons of privacy, said after several hospitalizations for anorexia, beginning when she was 21, she found a residential center in the Southwest on the Internet and spent six weeks there. The center, which she described as “more like a resort,” was “somewhat helpful,” she said, but not worth the time and money.
“People were nice, and the food was really good,” she said. “I had fun, I enjoyed rock climbing and stuff, but that’s not why I was there. I’m paying a lot of money to get well, not to rock climb.”It was also expensive. Mr. Bilkie, a financial adviser in Michigan, calculated that over three years, he paid at least $350,000 for unreimbursed inpatient care for his daughter. The Eating Recovery Center, he said, sent him bills for $30,000 each month. Mr. Bilkie paid willingly — he was desperate to see Ashley get well, he said — but no program seemed to produce lasting results.“We spent an outrageous amount of money for what really amounted to ineffectual treatment,” Mr. Bilkie said.
With a need to fill more beds, marketers for some centers make cold calls to psychiatrists, psychotherapists, medical doctors and others who treat eating disorders, offering to inform them about a program’s advantages and inviting them to visit.The Denver-based Eating Recovery Center has a call center and employs 20 “professional relations liaisons” who contact clinicians across the country. The author and motivational speaker Jenni Schaefer, who recovered from an eating disorder, recently joined the program’s outreach team. On its website, the company, which began with a single center, bills itself as “the only national health care system devoted to serious eating disorders at all levels of care.”