Finding an eating disorder therapist is hard. This program aims to change that

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ospitalizations for eating disorders among youth rose dramatically during the pandemic.

Nationally, eating disorder emergency department visits for females ages 12 to 17 years old doubled during the past few years, according to a 2022 report by the Centers for Disease Control and Prevention.

Locally, Seattle Children’s Hospital reports admissions for eating disorders spiking 27% between 2019 and 2021.

These are mental health disorders that can persist for years, and the stakes are high. If left untreated, eating disorders can cause serious health complications and become fatal. Of all mental health disorders, they have one of the highest mortality rates.

But for many people around Washington state, finding mental health treatment for eating disorders within their community can be incredibly hard, especially for low-income patients who rely on insurance programs like Medicaid.

In an effort to close that gap, Seattle Children’s Hospital started a training program for mental health care providers to learn the ropes of treating patients with eating disorders.

The idea is simple: train more mental health providers to treat eating disorders, especially in community health centers where Medicaid patients can access care.

Even pre-pandemic, Cynthia Flynn said providers at Seattle Children’s Hospital had trouble referring patients to therapists once they were discharged from the hospital.

Flynn is a clinical psychologist and director of the eating disorder program in psychiatry at Seattle Children’s.

Outside the Seattle area, especially east of the mountains, there just weren’t that many options.

"What we want to do after hospitalization is make sure that someone can go home and have an outpatient mental health therapist, and also medical follow up and nutrition, if that will be helpful for them,” Flynn said.

“It was really difficult to put those things in place, particularly the mental health therapy component," she added.

As the need for those resources rose during the pandemic, things got even harder.

Things like upended routines, isolation, and emotional distress are possible factors in the increase in young people experiencing disorders like anorexia, bulimia, and binge-eating.

“It got harder to get people in, wait lists started lengthening," Flynn said.

Since starting, the Eating Disorder Treatment Network has provided initial training to 110 therapists from 18 organizations around the state. About a third of those providers have gone through extra training to receive certification.

The program was devised prior to Covid-19, but it came to fruition at a time when demand was accelerating. The hope was to expand the network of people that can take patient referrals around the state.

Bringing treatment closer to home

Sally McDaniel is a counselor at Greater Lakes Mental Healthcare in Lakewood, Pierce County. She received certification to treat eating disorders through the Eating Disorder Treatment Network in 2021.

For years, her clinic lacked the expertise to treat eating disorders and had to refer clients elsewhere. But McDaniel said those referrals often went nowhere.

Multiple factors likely contributed, she added, including a lack of providers that take Medicaid in the community, out-of-pocket costs that were too high, and available treatment being full or more intensive than patients could commit to.

Now, eight therapists in McDaniel’s organization have gone through the training with Seattle Children’s and are treating young people with eating disorders.

The demand was always there; now at least some of it is being met.

McDaniel said she and her colleagues work to make sure their clients are attending medical appointments, and make sure they’re supported at school.

"We work in all parts to keep them in the community because stepping down from an intensive outpatient or an inpatient to the community is too big of a step.”

McDaniel knows firsthand how important it is for young people to get that treatment early on. Her adult daughter has had an eating disorder since she was young, and still faces challenges.

“It wasn’t treated when she was young. It wasn’t identified early enough,” McDaniel said.

Eating disorders can affect anyone

The typical age of onset for an eating disorder is early to mid-adolescence.

To catch it early, diagnosis and treatment resources must exist and be accessible.

For Emme Leonard, now 19, it was the start of the pandemic when her eating disorder really began to have an impact.

Leonard was a runner at Bishop Blanchet High School in Seattle. She was in her junior year, facing college scouting. She felt pressure to improve her race times and eventually became fixated on losing weight to reach that goal.

“As soon as I started losing weight, it’s like it started to spiral really fast,” Leonard said.

By the summer of 2020, Leonard was hospitalized and diagnosed with anorexia nervosa, an eating disorder characterized by weight loss, difficulties maintaining a healthy body weight, and sometimes distorted body image. People with anorexia often restrict food and some exercise excessively and purge.

Even after being hospitalized, Leonard said she was still in denial. She had an image — a result of stereotypes and stigma — of what an eating disorder was, and she didn’t think she fit the bill.

She was very conscious of what she was eating and how many calories, but it wasn’t all about food. Leonard was also over-exercising. In her mind, she was being healthy.

There were also societal forces that reinforced her choices, like how weight loss is often received with praise.

“I could not fathom that I might actually have an eating disorder,” Leonard said.

One study found eating disorders to be more common among athletes in high school when compared to non-athletes. They’ve also been found to be more common in women.

But anyone can be affected by eating disorders.

A 2020 report estimates that 9% of Washingtonians will have an eating disorder in their lifetime.

After being hospitalized a second time, Leonard came to terms with the fact that she was facing a significant mental health challenge and decided she wanted to go to residential treatment.

“I was really, really scared. Deep down, my body didn't feel good, my mind didn't feel good," she said.

But scarcity persists throughout the spectrum of care. Even for people with private insurance like Leonard, residential treatment was hard to find during the pandemic.

She was on wait lists that were weeks long.

Her family initially faced a wrenching decision when the only program that could take Leonard quickly was in Minneapolis.

But then a spot opened up at a program in Bellevue, just over 30 minutes from home. Leonard checked in just days after leaving the hospital. Most of the other patients in the program had traveled much farther for treatment.

Had Leonard ended up having to wait weeks for care, she said it would have been very challenging.

“I think there’s a high probability that I would have relapsed and ended up back in the hospital because I was not in a good place mentally then,” she said.

These days, Leonard is a second-year student at the University of Washington. Part of the draw of attending the university was that it kept her close to home — close to her support system.

She’s recovering and continues to work with a therapist. She’s now on an educational path to becoming a doctor.

Other barriers to care

The landscape of eating disorder treatment has improved slightly in Washington state in the past couple of years.

In addition to the training program at Seattle Children’s, the increase in telehealth options has helped expand access to care.

But there’s more work to be done.

Telehealth options aren't suitable for everyone. Things like a lack of reliable internet access or lack of privacy in the home can mean young people dislike virtual therapy.

Additionally, more providers need to be trained to treat eating disorders, especially in rural areas.

As the work to expand treatment options for people across the state continues, Dr. Yolanda Evans said it’s important to think about who the diagnostic and treatment tools have traditionally been designed for.

Evans is the medical director for the outpatient eating disorder program at Seattle Children’s Hospital.

“The research for how we approach things, and in our care, it’s really been done in a more homogenous population,” Evans said.

Research has historically centered mainly on white women. Approaches geared toward that demographic may not work for everyone.

“Someone who may be living in a higher weight body or may have cultural differences in food and how meals and snacks are structured may present differently,” Evans said.

Evans added that different cultures also value different body shapes and sizes, so traditional screening tools that may flag an eating disorder in one person may not be sufficient for another.

Similarly, she said people in the transgender community may have eating disorders that manifest differently.

“I think there’s a lot of work to be done to instill cultural awareness and humility and recognition of differences in the eating disorder care,” Evans said.

Like many aspects of health, when it comes to eating disorders, Evans said disparities in getting a timely diagnosis and access to care persist for many marginalized populations.

She said she wants to see more research funded and brought to the forefront that can result in effective, long-term care for all communities.