Questions and Answers with Stuart Koman, Ph.D., Chief Executive Officer of Walden Behavioral Care

Q: Your "continuum of care" approach to mental health treatment was originally developed by you and your business partner, David Fassler, M.D., at Choate Health Systems in Woburn. How did you happen to leave there and start Walden Behavioral Care?

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 Choate Health Systems 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.

Walden Behavioral Care came about much more by synchronicity. 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 Behavioral Care first opened, you took over the psychiatric unit from Waltham Deaconness. But you have grown beyond that original mental health program.

A: Walden Behavioral Care opened at midnight the day that Waltham Deaconness 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.

Walden's eating disorder continuum of care has really grown and developed. Our eating disorder unit is a lot different than the old unit. It includes all ages (starting at 13), 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.

At Walden Behavioral Care, we also are developing our own unique brand of eating disorder 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 you have expanded to Northampton, Massachusetts as well?

A: Walden Behavioral Care recently opened a satellite office/clinic in Northampton, Massachusetts and we are looking to develop (another satellite office/clinic on the South Shore in the near future.

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, Massachusetts at a health club.

A: Dedham is a pilot program located at Dedham Health & Athletic Complex, 200 Providence Highway, 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, Walden Behavioral Care also runs a psychiatric inpatient unit.

A: Walden's 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 the eating disorder and psychiatric 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: Anorexia is the most lethal of all psychiatric behavioral disorders. Up to 20% of people with anorexia will die from that disorder. I was astounded when I first learned that fact about eating disorders.

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.

About Stuart Koman, Ph.D., President and CEO

Stuart Koman, Ph.D., is president and CEO of Walden Behavioral Care in Waltham, Massachusetts; a principal at the Executive Performance Group; and a senior clinical advisor to the Public Consulting Group. Before that time, he was president of Charles River Health Management, a psychiatric contract management division of Community Care, Inc., and served as a member of the Governing Board of the American Psychological Association's practice division from 1992 to 2000. Koman is also an author and co-editor of the Handbook of Adolescents and Family Therapy.