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Walden executive
discusses whole health approach to care
(May
2008 Issue)
Like a phoenix rising from the ashes of financial collapse, Walden
Behavioral Care, located in what was once Waltham Deaconness Hospital,
has built itself into a powerful new player in the field of eating
disorder treatment. Invited by the Commissioner of Mental Health
to save the 45 mental health beds that would be lost when the hospital
closed in August 2003, Stuart Koman, Ph.D., and David Fassler, M.D.,
joined forces to create Walden Behavioral Care, a facility that
would incorporate both the inpatient psychiatric facility and its
eating disorder program.
Using a whole health approach to care, Walden is now one of the
largest providers of eating disorder treatment in New England and
one of only a handful of programs in the country to offer these
services for both men and women. Set up to treat patients with co-occurring
disorders all in one facility, Walden operates on a "continuum of
care" model, providing inpatient, residential, partial and intensive
outpatient care.
New England Psychologist's Catherine Robertson Souter spoke
with Koman, the president and chief executive officer of Walden,
recently to discuss the program, the successful business plan and
their plans for expansion.
Q: You and your business partner, David Fassler, M.D., had previously
run Choate Health Systems in Woburn, where you first developed your
"continuum of care" approach to mental health treatment. How did
you happen to leave there and start Walden?
A: At the time we left Choate, it had become painfully obvious that
even though our clinical programs were well received, most of the
new managed care contracts were going to the larger facilities.
The insurance companies were contracting with the larger facilities
for other services, like cardiac care and the psychological services
were kind of a throw-in at the end of the negotiation.
We sold the company at the point of time when it looked like we
would have a problem competing for managed care business and we
got back into the business at a time when the managed care wave
had resulted in the closing of many facilities and left the behavioral
care market underserved. Utilization went up and then everybody's
reimbursement went up.
This particular thing came about much more by synchronicity, this
program closing and us getting back into the market. There was a
concern by the commissioner of the Department of Mental Health,
Marylou Sudders, about the closing of Waltham Deaconness. She knew
about the Choate experience and she was hoping that we could save
these beds.
Q: When Walden first opened, you took over the psychiatric unit
from Waltham Deaconness. But you have grown beyond that original
program.
A: We opened at midnight the day the hospital closed. We took over
the 45 inpatient beds that existed: half adult locked beds and the
other half a dedicated eating disorder program, an inpatient hospital
program.
We've really grown and developed our eating disorder continuum
of care. Our unit is a lot different than the old unit. It's all
ages, both sexes and we take a broader group of individuals - not
just anorexia and bulimia, but binge eating and people who have
major co-occurring problems both physically and psychiatrically.
We also are developing our own unique brand of outpatient care
which is a combination of family therapy, nutrition education and
psychiatric medical monitoring.
We started out with idea that we would have to be entirely competent
medically, psychiatrically and behaviorally and we've gone further
than that. We have our own internal medicine doctor, three nurse
practitioners and a consulting roster for additional help.
Q: And physically, the facility is growing as well.
A: We lease the entire fifth floor and some other areas in the hospital
and we've spilled over into the medical office building. We have
now opened up a residential program in the new luxury apartments
that were built where the parking lot from Waltham Hospital used
to be.
We recently opened a satellite office/clinic in Northampton and
we are looking to develop one on the South Shore.
Between inpatient programs, partial hospital, residential, intensive
outpatient programs, our binge eating program and our new program
in Northampton, there are about 70 eating disorder patients getting
treatment every day.
Q: And you have a new program in Dedham at a health club.
A: Dedham is a pilot program, the first of its kind, a combination
of behavioral treatment, nutrition, education, psychiatric consultation
and exercise programming focused on treating binge and night eating
disorders. The exercise programming is unique - nobody is really
using exercise as a treatment modality in the way it should be.
Q: Not to forget, you also run a psychiatric inpatient unit.
A: Our psychiatric unit is also a very highly sought-after program,
a well-respected program. One of the things that we try to do with
both units but it is a little more difficult with the psychiatric
unit is to make it physically attractive and socially respectful.
We've had good feedback from families, remarking how quiet it is.
You can feel pretty comfortable dropping off a loved one that they
are going to be okay, it's not a dangerous place.
We also get individuals with eating disorders but who have more
pressing psychiatric problems and have to be in a locked setting.
While our eating disorder program is a voluntary unit, our locked
unit is capable of taking care of individuals at very acute points
in the disease process.
Q: What needs to be done to stem the tide of unhealthy food-related
behaviors in Americans?
A: One of the astounding things I learned early on about eating
disorders was that anorexia in particular is the most lethal of
all psychiatric behavioral disorders. Up to 20% of people with anorexia
will die from that disorder.
That's one end of the continuum - anorexia and bulimia, and then
you think about binge eating and night eating and obesity at the
other end of the continuum, whose numbers are just flat out astounding.
Upwards of 35-40 percent of the population of the US are overweight
or obese.
Along with treatment intervention, we need cultural intervention.
My dream this year is to launch a small foundation whose purpose
would be three-fold: public education and awareness, raising money
for research and scholarships for people who can't afford to come
here because they have no insurance to do it.
We actually do a lot of training here, mostly free of charge. We
mainly focus on school nurses and guidance counselors, along with
mental health professionals and college level coaches.
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