“abundance not scarcity. Both/and, not either/or”

The last seven days have been unusually discouraging as an executive in the field of treating diseases that have killed several in my family and nearly destroyed my own life a few times. I am in this field because I care and because At SunCloud we are blessed to have a leader who we all respect and love. She’s operates with such incredibly integrity, a laser like focus on quality of care for our patients and a commitment to the medicine she practices that is second to none. We believe in what we are doing, we are in it because we care, and we know the work we are doing saves lives. That’s why these events were so depressing to see, and a fresh reminder of just what a great thing we have going at SunCloud. 

I watched a professional webinar in which speakers ignorantly and aggressively blasted a treatment modality that I have personally witnessed work like a miracle for my best friend (and hundreds of others). I listened to payers and providers fight over whether or not to extend “telehealth parity” in Illinois without any regard whatsoever for quality measures. Moreover, I was told by another treatment provider that it would not sublease an empty office suite to SunCloud Health because we are a “competitor”. 

SCH is an organization that believes in and adheres to the “both/and” mentality rooted in concepts of abundance, collaboration, inclusion, and value.  All three of these events that I experienced this week were predicated on an “either/or” viewpoint based on scarcity, fear, exclusion, and ignorance.  In addition to being reminded how grateful I am for the company we have created; I was also reminded repeatedly that for every obstacle there is an opportunity to educate and unify.  

At SCH we recognize that we are blessed to be in this position. We take not one second of this journey for granted and know our voice is but one of billions.

First, the title of this highly depressing webinar was something along the lines of, “Why Not to Use 12-Step When Treating Eating Disorders (Eds)…”  It could easily have been labeled, “How 12-Step Will Hurt Patients with EDs,” given the tone and the way it was presented.  I am not endeavoring to make a research-based argument as to the effectiveness of community support such as 12-Step for those struggling with eating disorders; however, I am saying in no uncertain terms that the way in which this counter argument was presented was personally offensive and without any credible evidence.  It was presented as if this particular evidence-based modality isn’t for anyone struggling with eating disorders without any regard for the type of eating disorder the person might be struggling with or other co-occurring disorders the person might have. It was black or white. “This won’t work for anyone” …  It was just dumb. 

The presentation totally disregards the fact that for some individuals, food is an addictive substance. Therefore, the “all foods fit all people in moderation” model might be good for most but not for the person with food addiction. The person with food addiction has an addiction. We know 12-Step is evidence based for substance use disorder. When certain foods are the substance in an addiction, 12-Step should certainly be an option for this patient and abstinence from the triggering food for the person with food addiction (not to be mistaken for restriction), can save that person’s life. 

The presentation suggests that sponsorship, aka mentorship, always leads to codependency and this is unhealthy. This is foolishness. Yes, this unhealthy dynamic can happen in any mentor mentee relationship, but it doesn’t happen most of the time and certainly not all the time, as suggested in this presentation. The presentation criticizes 12-Step for not having professionals run the groups. Of course, participants know that most support groups including 12-Step are comprised of nonprofessionals. For treatment of any mental health condition including EDs, everyone must seek officially recognized treatment and help from a professional.  Support groups are intended to serve as an adjunct to professional input, never a replacement.  

All arguments contained within the webinar indicate that this treatment modality is dangerous for people struggling with Eds. This is absurd because it suggests that everyone with food-related disorders possesses the exact same condition, which is not true. For some, ongoing 12-Step support is a life saver, while for others, it is not a good fit. This isn’t any different than any other treatment modality for every other condition. Our job as professionals is to understand our patients and apply the tools and interventions at our disposal that are appropriate, and evidence based for their disease and for them. Treating eating disorders this way requires a highly sophisticated approach with educated, crises trained and devoted providers. It’s easy to apply the same one model to everyone that walks in your door. It’s way more complicated understanding your patient once they walk in the door and then applying a unique hybrid model for every single one of them based on their condition. 

Every single patient is an individual with specific needs, which is why the use of any treatment modality should never be an all-or-nothing proposition. This entire webinar was painful to watch, and I kept hoping attendance was low. 

Second in my week, was listening to providers and payers argue about telehealth parity in our post-COVID world. This was without regard for quality measures. This only served as a reminder that in the field of mental health and addiction treatment, no standardized quality measures exist.  How is this possible? If telehealth works as well as in-person treatment, the price equation will look a whole lot different than if it doesn’t work as well. And vice versa. For so many reasons, we desperately need to agree on standardized quality measures for the sake of our patients.  

And third on this unfortunate list, was the issue of relocation. We are looking to move, not only for additional space, but to ensure we can take appropriate steps to follow a post-COVID treatment spacing protocol. A few weeks ago, I unknowingly walked into a set of offices, previously occupied by another ED provider in the Chicago area. Apparently, this group moved out earlier this year due to lack of space. The area offered the basic nuanced elements of a treatment center such as group rooms, a space for meal support, individual offices for therapy, etc. I learned that the former occupants had three years left on their lease at a cost of $30K per month. Since little interest had been shown toward the property, I figured we could reach a mutually beneficial agreement. I was wrong. 

After two weeks of no response, I personally reached out to the leader of this program. I was told that, even though this company would be relieved from a significant financial burden, subleasing was not possible. The reason was that SCH was “deemed to be a competitor.”  To say that I was shocked is a profound understatement. First, our treatment is very different from their approach. And foremost, they were literally placing their interests above that of people in need throughout Chicago. Currently, demand eclipses supply. It is not unheard of for people to wait upwards of four weeks for quality care. 

At SCH, we habitually place the interest of patients above our own and operate on a foundation of abundance.  There are always enough patients to go around. Our treatment model is inherently inclusive.  In addition to those with EDs, we treat people struggling with complex, co-occurring substance use, mood disorders and related trauma; all of this is done simultaneously and under one roof.  While our model is not for everyone, we believe it works far better than tracking people and forcing them to decide if they want treatment for one thing or another, but not both and certainly not all of it at once.  We know what we do well and what we don’t.  Since opening our doors, we have operated with a laser-like focus on increasing value for our patients and their families as well as for payers. We are collaborative by nature and anchored in abundancy, trust, and transparency. Rarely do we support our patients in an either/or scenario, but rather by taking a both/and approach to just about everything. Our patients are unique individuals who deserve to be treated as human beings with certain needs. No two patients are identical with the same treatment goals. Even though we know that individualized approach requires far more work and effort on our part, it is the correct thing to do. We also know definitively, there is plenty of life and love to go around.

Although the events of this week were disappointing and discouraging, at the end of the day, I intentionally let them go. What matters at SCH is what we do, how we do it and who we help. Watching a child set free from a disorder or addiction, engaging with a family that is moving toward peace and healing, or interacting with a professional who can now return to the workplace without drugs or alcohol, is why I, and the rest of our staff, come to work each day. This is what truly matters.