Iowa's only inpatient eating disorder unit to close

Iowa’s only inpatient eating disorder unit to close

IOWA CITY, Iowa (AP) — Margaret Tillotson is on the road to recovery.

The 22-year-old woman from Burlington has suffered from anorexia nervosa for years. During her lowest point, Tillotson – who is 5ft 10in – said she weighed just 113lbs.

Now her health has improved and she is back in school, thanks to what she described as a life-saving inpatient program at University of Iowa Hospitals and Clinics for patients suffering from eating disorders.

“I wouldn’t be here if this program didn’t exist,” said Tillotson, who has been admitted to the program six times in the past three years.

But after hospital officials announced plans to phase out the program later this fall, Tillotson worries about her ability to access a higher level of care if she relapses.

The 13-bed inpatient unit is the only such program in Iowa, and its closure could lead to inequitable access to treatment, patients and healthcare providers say.

Patients will have to “get out of state or they won’t have access to treatment at all,” said Dr. Sara Schwatken, a Fort Dodge psychologist who specializes in treating eating disorders.

The Des Moines Registry reports that patients facing this possibility include people like Tillotson, who rely on Medicaid for health care coverage. The state insurance program has historically denied members coverage for care in out-of-state programs such as those in Omaha, St. Louis and the Twin Cities.

The cost of care varies depending on the patient’s condition and length of stay, among other factors, but experts estimated residential care to be around $1,237 a day in 2018 and 2019, according to a report from the Harvard TH Chan School of Public Health.

Tillotson, who is enrolled in Iowa Total Care, said she’s been denied coverage for eating disorder programs outside of Iowa “more times than I can count.”

“I don’t know where I’m going to go,” she said. “My family can’t afford to pay out of pocket for me to get out of state.”

University of Iowa Hospitals stopped admitting patients to the unit last week, said Dr. Peggy Nopoulos, chair and chief executive of the UIHC’s department of psychiatry.

Current patients will continue in the residential program until they have completed their treatment and are discharged, she said.

In the past fiscal year, the residential program served 125 people, Nopoulos said.

The Inpatient Eating Disorders Program cares for the most serious patients whose disorder has placed them at medical or psychological risk.

Typically, this includes patients who are suffering from a life-threatening illness, such as malnutrition, and who require round-the-clock medical care and behavioral health support.

Many patients with eating disorders also struggle with other mental health issues, such as anxiety and depression.

The 2020 Harvard report estimates that 9%, or 28.8 million, of Americans will have an eating disorder in their lifetime. The report also estimates that 10,200 deaths occur each year as a direct result of eating disorders.

The UIHC Eating Disorders Program will continue to offer outpatient services and its partial hospitalization program, which includes structured weekday therapy sessions.

Patients requiring acute care will be admitted to hospital, officials said in a statement.

Ultimately, UIHC officials made the decision to phase out the residential program due to Iowa’s overwhelming demand for more mental health care, Nopoulos said.

According to hospital officials, the Iowa City-based health system is seeing “unprecedented numbers of people with acute mental health crises arriving in our emergency department.” They did not provide exact numbers.

Compounding that is the fact that Iowa ranks among the worst in the nation for a few mental health inpatient beds per resident, Nopoulos said. Iowa has about 24 psychiatric beds per 100,000 people, according to a 2021 study in the International Journal of Environmental Research and Public Health.

To help ease this tension, the dedicated inpatient eating disorder unit will be open to patients with a wider range of acute behavioral health needs later this fall.

By doing so, the hospital will be able to serve more patients each year. The average state of hospitalization for acute behavioral health patients is about 10 days, while residents in the eating disorders program typically receive treatment that lasts “several months,” Nopoulos said.

“A good 30% of our adult psychiatric beds had been dedicated to residential inpatient care for our eating disorders program, and opening those beds to general mental health care will allow us to serve approximately three times more Iowans,” Nopoulos said.

Only four patients remained in the inpatient program as of Sunday April Bannister, a current patient on the unit told the Des Moines Register.

Bannister, a 22-year-old from Iowa City, has participated in the program seven times since February 2021. She was most recently admitted on July 20 after a therapist discovered she had lost weight.

When hospital management announced at a Sept. 1 meeting that it was phasing out the program, Bannister said he saw many staff members cry. His social media post about the meeting helped generate a petition that garnered nearly 7,500 signatures on Monday.

The petition contains dozens of comments from former patients and family members of patients who participated in the program, sounding the alarm about the phase-out and calling on hospital leaders to save the inpatient program .

One commentator, Angela Kerchner, said her daughter nearly died of anorexia, adding that it was “incredibly difficult to find a cure”.

“This is a devastating loss for so many struggling people, patients and families,” she wrote. “We need more mental health treatment in Iowa, not less.”

The Eating Disorder Coalition of Iowa raised similar concerns in a letter to University of Iowa Hospitals last week and requested additional information about the hospital’s future steps to provide care for patients with disorders. food.

“In addition to advocating for in-state eating disorder treatment resources, our long-term plan also includes increasing our advocacy efforts to address the appalling denial of out-of-state coverage for higher levels of care,” coalition officials said in the letter provided to the Des Moines Register.

“We also plan to discuss concerns and encourage treatment coverage with Iowa-based insurers, beginning with Iowa Medicaid plans.”

Bannister said she understands the hospital’s decision to expand access to mental health care and supports the hospital’s efforts to reach more patients.

But she thinks the way to get more beds “isn’t to cut the eating disorder program.” She worries that patients with eating disorders who can’t travel out of state will walk through the hospital without getting the intensive treatment they need.

“Without therapy and therapeutic meals, this program is nothing,” Bannister said. “If you take those resources away and put them in a hospital, yes, you medically stabilize them, but you won’t fix any underlying issues.”

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