When Linden Hills resident Kitty Westin’s daughter Anna died in February 2000 after a five-year battle with anorexia, there were no residential treatment programs for eating disorders in the state of Minnesota.
Eating disorders were poorly understood and often trivialized. Kitty Westin, who then lived in Chaska, was a licensed psychologist, but her training had barely touched on them. Anorexia was sensationalized in made-for-TV movies as a behavior problem mainly affecting models. And Anna’s insurance company had told her that the therapy and hospitalization she needed “wasn’t medically necessary.”
“It’s almost unspeakable, just horrific, to watch something like that happen and to feel so helpless and alone,” Kitty Westin said. “Had residential treatment been available to Anna at that time, I think she’d be alive today.”
The past two decades have seen a tidal shift in the perception of eating disorders by the public and the medical community — thanks in no small measure to the advocacy of Westin and her husband, Mark, and to the work of the foundation they started with money received from Anna’s insurance company in a “wrongful death” settlement. In 2016, President Obama signed the Anna Westin Act into law, improving eating disorder training for health care professionals and mandating insurance coverage of intensive treatment programs.
Now, Minneapolis’ first ever residential treatment program for eating disorders is coming to Linden Hills. On Sept. 9, The Emily Program will open a 16-bed treatment facility just 11 blocks from the Westins’ home at 38th & Drew. And, like the organization’s two residential facilities in St. Paul, it will be named after the Westins’ daughter.
“It was so exciting when they told me that they were bringing the next Anna Westin House right here to my neighborhood,” Kitty Westin said. “It’s like bringing her home to us.”
The new facility will house the Emily Program’s most severe cases — patients of all genders suffering from disorders like anorexia, bulimia and compulsive overeating who require 24-hour medical care. The Linden Hills location will primarily serve patients between the ages of 16 and 26; younger and older clients will be sent to one of the Emily Program’s St. Paul locations.
Over the past six months, The Emily Program has spent $1.4 million renovating the three-level, 13,000-square-foot brick building at 3012 W. 44th St. — a former convent that was constructed in 1958 by St. Thomas the Apostle Church. Converted into a group home in the late 1980s, the building had been vacant since 2003 and needed asbestos abatement and water damage repair.
Offices have been added to accommodate the Linden Hills facility’s 42 staff members: doctors, psychiatrists, dietitians, therapists, nurses, eating disorder technicians and cooks — about two-thirds of whom will work full time at the location. Walls have been knocked down to make space for an art therapy studio and for double- and triple-occupancy bedrooms. A modern kitchen and soft seating have been installed. Windows will be added to the chapel’s domed roof so it can serve as a yoga space.
“The goal was to turn it into a medical facility that feels like a home,” said Jillian Lampert, the Emily Program’s chief strategy officer.
Lampert said about 180,000 Minnesotans will experience an eating disorder at some point in their lifetime, with women twice as likely as men to be affected. Of the 3,000 patients the Emily Program serves in Minnesota, around 15% will need residential treatment, she said.
Right now, with the Linden Hills facility yet to open, there are 71 beds for residential treatment of eating disorders in Minnesota, all of them located in the metro area.
While the wait list for residential treatment at the Emily Program is four to six weeks, there is currently no wait list at the 39-bed residential facility at Park Nicollet’s Melrose Center in St. Louis Park.
“Sometimes we have patients who come here on referral from the Emily Program, and we evaluate them and our recommendation is not residential,” said Heather Gallivan, clinical director of the Melrose Center. “It’s public knowledge that they’re a for-profit health care organization and we are not.”
The Emily Program is partially owned by TT Capital Partners, an Edina firm that looks to invest in “companies with the ability to be market leaders,” according to its website. Responding to expanded reimbursement options, private equity firms have invested heavily in eating disorder clinics in recent years.
But Lampert said business needs never dictate the level of care patients receive and that eating disorders’ severity can shift quickly.
“It’s strictly a clinical determination,” she said. “I think patients — consumers — make different choices about their health care in terms of where they want to go. People often wait because they know the program, their team is here, they’re comfortable here. It could be an insurance coverage issue. There are lots of factors that influence where people end up.”
Misconceptions and treatment
Dawn Boettcher, the site manager of the Anna Westin House in Linden Hills, said eating disorders are the subject of more skepticism and misconceptions than many other types of mental disorders.
The truth, she said, is that eating disorders are not caused by family dynamics. They are not driven by behavior but biology. And they are not diagnosed by evaluating the size of patients’ bodies.
“Size does not indicate health any more than it indicates illness,” she said. “There can be health at any size and people can be in need at any size.”
Eating disorders are “biopsychosocial” in nature, according to psychiatric researchers, and they affect people of all genders. In the United States, about 6% of adult women, 3% of adult men, 8% of adolescent girls and 4% of male boys experience an eating disorder, Lampert said.
“If you have a severe eating disorder, you have a brain disorder,” Kitty Westin said. “We also know that the culture we live in — which I call the ‘toxic culture of thinness’ — is a contributing factor. And people with certain personality traits tend to develop eating disorders.”
Westin said her daughter Anna — whom she described as “loving, kind, perfectionistic, really sensitive, willing to do anything for everyone” — fit the profile of a person susceptible to eating disorders.
Boettcher said a primary goal of treatment is “to reintroduce and normalize and stabilize eating patterns.” Patients engage in cooking groups, meal planning exercises and grocery shopping trips and are discouraged from attaching moral values to food.
“Our philosophy is ‘all foods fit,’” Boettcher said. “We’re eating three meals a day and up to three snacks a day. Meal times are really structured and, because we’re dealing with eating disorders, they become really therapeutic as well. There is a lot of fear, a lot of anxiety, a lot of emotion when you sit down to a meal with an eating disorder.”
Cost of care
Before the Anna Westin Act passed, Lampert said insurance companies frequently excluded eating disorders from coverage.
“I remember reading a client’s insurance policy that said, ‘Your policy does not cover wilderness, camping, selective cosmetic surgery or residential treatment for eating disorders,’” she said. “It was so striking of how it was thought of as a medical service.”
An average stay at an Emily Program residential facility lasts about 30 days and has a pre-insurance cost of around $1,000 per day, but Lampert said residential programs are significantly cheaper than in-patient hospital care.
“If you go into a hospital room, that’s going to be thousands and thousands and thousands of dollars a day,” she said. “We allow patients to stay for the length of time they actually need to recover rather than a quick-turnaround hospital stay.”
When Kitty Westin first became involved in eating disorder advocacy in the years following Anna’s suicide, she said her long-term goal was to bring residential treatment to Minnesota.
“After she died, I had this incredible amount of rage and energy and outrage, and there were so many things that could have gone differently,” Westin said. “Anna’s legacy is that people now have access to the type of residential care that she didn’t have herself.”
Westin has a message to share with the parents of people suffering from eating disorders: “There’s every reason to believe that your loved one will completely recover.”