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Renfrew Center marks 25 years treating eating disorders

When Sam Menaged, founder and CEO of the Renfrew Centers, first floated his idea for a residential eating disorder facility for women 25 years ago, he didn’t get much support. It was the early 1980s and eating disorders – like anorexia nervosa and bulimia – weren’t part of mainstream culture yet.

“It was never in the news – it was never in the paper,” Menaged recalled. “It simply wasn’t talked about.”

Menaged’s colleagues at the Horsham Clinic, a private behavioral health care facility in Ambler, shot down his suggestion of adding an eating disorder facility. They told him there wasn’t enough demand and that the idea was too risky financially.

At the time, a residential facility singularly focused on treating eating disorders was an entirely new concept. Patients with eating disorders were typically treated in hospitals alongside patients with other psychiatric disorders.

The young healthcare lawyer was undeterred. After visiting several hospitals and talking with patients and psychiatrists, Menaged was convinced there was a more effective way to treat eating disorders, and he soon left the Horsham Clinic to prove it.

Menaged wanted to create a facility that was distinctly different from the hospitals he had visited. He found them too sterile and unwelcoming, their approach to treatment too narrow-minded.

The hospitals, he explained, were only treating symptoms of eating disorders. If the patient was anorexic, the focus was weight gain. If the patient was bulimic, the focus was stopping the binge and purge cycle.

“The problem with that,” Menaged said. “is there is no insight therapy. There’s nothing in place to teach the patient how they got there, to help them understand why they got there.”

To address this shortfall, Menaged wanted his program to have an intensive therapy component so that patients worked on the emotional and physical facets of their disorder. But, Menaged added, he wanted recovery to be a two-way street, where patients were actively engaged in treatment.

The facility also had to be residential, so patients could recover in a friendly, community environment with other eating disorder patients and away from patients with other psychiatric disorders.

Dr. Susan Ice, Renfrew’s medical director in Philadelphia, said following through with this concept was critical.

“These are very cagey, tricky people,” Ice said. “They’re smart. So if you put them on a general psych unit they would get away with murder. They’d not be eating. They’d be binging and purging because you don’t worry about that stuff with a general psych population.”

Menaged’s vision intrigued Eleanor Houston Smith, a Pennsylvania Railroad heiress who was looking to sell her family’s 27-acre Philadelphia estate nestled in the Schuylkill Valley on Spring Lane near Roxborough. Menaged had seen the property listed in The New York Times and thought it would be a perfect place for women with eating disorders to come to focus on recovery. But Menaged needed time and money.

Securing funding for a first-of-its kind eating disorder facility wasn’t easy. Menaged needed money to purchase Houston’s plot and to open and operate the center. Luckily, a friend from Menaged’s days at Yale University provided the capital to get the center started. But to purchase the property, Menaged would need a sizable loan: $3.5 million.

A half-dozen Philadelphia-area banks denied Menaged’s loan request. Like his colleagues at the Horsham Clinic, they thought a residential eating disorder facility was too risky.

But Menaged – determined to succeed – shopped his idea to banks outside the city and soon found a bank in Maryland to provide the loan. In June 1985, nearly two years after Menaged first approached Houston, the Renfrew Center opened its doors with five clinicians and five administrators.

Menaged said it was hard to find people that were not only skilled, but prepared to take on the challenge of working in a facility with no set standards.

“We found good therapists who knew how to do therapy,” Menaged explained. “I found a couple of people who knew something about eating disorders from private practice. We built the program through working with patients, trial and error.”

He said it was difficult getting patients to come to the center at first. Though eating disorders weren’t kept secret as much (singing star Karen Carpenter had recently died from complications related to anorexia nervosa), Menaged said most women still weren’t comfortable seeking treatment.

“They were in denial a little bit,” he added. “They knew they had a problem, but they were convinced there was no hope.”

Menaged recalled that many women had been treated in hospitals for eating disorders and didn’t think the Renfrew Center’s program would offer them anything new. Still within two years, he said, all 58 beds were full.

Over the years, Ice, who has been with the Renfrew Center for 10 years, said the center has broadened its scope of treatment. When Renfrew first opened, the center focused on treating teenagers and young adults. Now, Ice said, patient ages range from 14 to 67, and, accordingly, Renfrew has had to create specialized recovery tracks.

“The one thing patients have in common is they have an eating disorder,” Ice said, “and everything else they don’t have in common. So you try to manage what they have in common together and then you create subpopulations.”

Daralyse Lyons, a former patient, said Renfrew’s individualized approach to treatment was a big reason why her stay at the center was successful. Now 26, Lyons had struggled with eating disorders – first for anorexia and later bulimia – since she was 14 years old.

“I kind of thought I’d spend the rest of my life in and out of treatment facilities,” Lyons said. “I just thought I would accumulate accomplishments between rehabs, so to speak.”

Eileen Binckley, another former patient, shares Lyons’ sentiments. Binckley, who suffered with anorexia her entire adult life, didn’t seek inpatient treatment until she was 51. She said the fact that Renfrew had a track for women her age, made the prospect of becoming a patient less nerve-racking.

Ice said Renfrew also has had to create a “continuum of care,” a way for patients to step their way down through recovery. She said the move was a partial reaction to the introduction of managed care companies, which in most cases cut the number of days at the center covered by a patient’s health insurance.

Menaged said that before managed care started in the mid-90s, patients, on average, stayed for 50 days. Now, he said, it’s closer to half that, but added that the time is often fragmented into two or three day stints.

To make treatment an option regardless of insurance plan, Renfrew now offers day treatment five days a week, intensive outpatient treatment three days a week, and once-a-week therapy sessions.

“The idea is that you can’t have someone come into a high intensity treatment program and say ‘OK, time to go,’” Ice said. “You’re going to go back to your outpatient therapist and nothing in between.”

In 2009, the Renfrew Center opened its tenth location in Dallas, Texas. (There are additional locations in Florida, New Jersey, New York, Connecticut, North Carolina, Tennessee and Maryland).

Over the course of its 25-year history, Menaged said the Renfrew Center has treated more than 50,000 women and adolescent girls.

Asked about the lack of support he received when he first set out to start Renfrew, Menaged smiled.

“I guess I proved them wrong,” he said.



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