I did another review of Walden Behavioral Care on the ED Referral Site. What I did was to amend the first review. Unfortunately, the site would not allow me to do italics, so I had to do the additions in CAPS. The Webmaster wrote to me and asked me to change them to italics (for reasons you can guess). I made this conversion and sent a Word document. Wordpress doesn’t like it when you copy and paste from Word….they have a wizard for this, but then the italics disappear. I will attempt to post the whole thing here.
ADMIN, IF THERE’S SOME WAY OF DOING THIS WITHOUT USING CAPS THAT WOULD BE NICE.
Hi everyone, this is my second review. I am amending my first review. I am using italics to differentiate between my amendments to my first review, and what I originally wrote about Walden following my February 2012 experience.
I have now been on Alcott twice in 2010, and twice in 2012. The two 2012 experiences were February and jolly, both times “sectioned.” I was also on the Thoreau unit in 2011, as I have stated here. So everything you see in italics is…well, you’ll see. Please read my whole thing before passing judgment.
When were you there: I was on the inpatient unit only, called Alcott, because I am on Medicare and Medicaid and none of their other programs take public insurance. My stays were in January 2010 for maybe a week, March 2010 for 16 days, and from February 8 until February 24, 2012. I was also on the Thoreau unit (often referred to as “the other side”) which is a purely psych unit, from September 1 (actually the 2nd, by the time I got there) until September 26, 2011. Despite what the Admissions people tell you, patients do get treated for ED on the psych side. Your care is a little different, though, and while I was there, most of the other patients were being treated for alcoholism, some for drug addiction as well, and a few who had psychiatric problems without a substance problem. Both Alcott and Thoreau are locked units. When you get there, you have to sign a paper called a “conditional voluntary” meaning that you are there willingly. If you don’t sign, they can commit you legally…or not, depending. To get out, you either get discharged or you can choose to put in a “three day,” a legal document requesting discharge within three days. This is standard for all locked units in Massachusetts. If your petition is turned down, you will be legally committed for the next ten days and possibly more, up to six months. This is all still the case. No Massachusetts laws have changed.
How many patients on average? On the inpatient unit I think there are 22 beds. Not all the people who sleep on the unit are actual Alcott patients. Some are Thoreau patients who commute over to “the other side” during the day and sleep at Alcott at night. There were one or two patients who actually were patients at their residential program (nicknamed “Rezzie”) but there were no beds available there. This program, the “commuting” program I’m referring to, is called by three letters, just can’t recall right now which letters…at any rate, they’ve ironed out the bugs in the program. If you are an Alcott patient, you needn’t really think about these patients. They are not around during the day. They do not eat with Alcott patients. They just sleep on the unit.
Does it treat both males and females? If so, is treatment separate or combined. If you are a guy, you are pretty much out of luck in any treatment center because in general, there are only one or two guys at a time and the rest are women. So if you’re a guy you might as well get used to having women around and talking to them and relating to them, because there’s no one else to talk to. If there was only one guy, he got a single room. The guys seemed to like this. They also showered at separate times, usually at night, while the women showered before breakfast. I don’t recall any separate men’s groups or any discussion of men’s issues. Every time that I was on Alcott, there would be a guy or two that stuck to themselves, either sitting in a corner, burying themselves in books or coloring, or just not speaking much, and no one even tried to talk to them. This was still the case. In July, there was one guy. A lot depends on the one guy and the rest of the population and how they treat him. I do feel sorry for the guys.
How often do you see a medical doctor, psychiatrist, psychologist (therapist), nutritionist, etc? Patients are admitted during the morning hours, and by the time they are brought up to the unit, it is afternoon and many of the “team,” that is, social worker, doctor or nurse practitioner, nutrition staff, or any other professional like that is generally too busy to see you or has left for the day. If you arrive on a Friday, you will have to wait till Monday to meet your “team,” or longer if Monday is one of those Monday holidays. But finally, you meet them. The medical doctor or nurse practitioner (it can be either) will see you daily and is supposed to be looking after your medical needs, blood tests, what you weigh, and if you have psychiatric issues such as depression or suicidality. There is only one of these doctors/nurse practitioners, no separate psychiatric specialist. The social worker will meet with you every other day and is supposed to be the liaison between you and your family and between you and your outside treatment team. The social worker is supposed to set up discharge plans as well. If you have any questions about your care, the social worker is supposed to answer them and will most likely be the team person to spend the most time with you. Nutrition will generally meet with you every other day or whenever there is an issue. The nutritionists are generally not available for counseling during the weekends or evenings. If you have an issue with your meal plan on a Friday evening, you will have to wait until after the weekend. On the weekend, the “team” isn’t there in general. Patients get lined up to see what’s known as the DOC, or, “doctor on call.” These doctors are usually farmed in from one of the many local medical schools. They spend all day there and will see you for a minute or two. The only issues that the DOC’s can solve are things like needing a Tylenol for a headache. Otherwise, they defer to the regular team. On Thoreau, though, the DOC system works a little differently because these docs are often responding to some psychiatric crisis, including everything from an allergic medication reaction to someone getting loud and violent, so they are at a bit more liberty to take action than the Alcott DOC’s. The psychiatrists do not read patient charts. I have evidence that they ask the same questions to every patient on the unit and the only thing they seem to read in the charts is the patient’s weight. If you are not gaining as fast as the insurance company wants, they stick a tube in. They will give you a line, “this is for extra nutritional support” or something like that. It’s only because they’re not going to get paid otherwise. I also have evidence that there have been cases of refeeding syndrome on the unit. This has been covered up. I’m sure they lie about the wrongful deaths. They also give the patients antipsychotic drugs such as Seroquel (this one they give quite a bit) and Olanzapine (zyprexa), which have the side effect of rapid and extreme weight gain and also associated diabetes. They lie to the patients and tell them they are giving them these drugs for the purpose of easing anxiety and insomnia. The nurses even admitted this to me.
What is the staff ratio to patients? Compared to other psych units I’ve been on, I’d say there are an unusually high number of staff. I have not been on another unit that was specified for ED except Alcott, ever. (I have been in psych units maybe 50 times including a state hospital, BTW.)
What sort of therapies are used? (DBT, CBT, EMDR) etc? They had some very basic DBT and CBT groups. They also had art therapy, which nowadays is called expressive therapies if you want to be politically correct. They have nutrition education groups as well. Sometimes, the addictions guy would come in from “the other side” and give a presentation or discussion group and relate addiction to ED. On Sundays some volunteers would come from AA and give a talk. The person who organized these was an “old timer” and many of the speakers had been through the wringer with alcoholism. This was not an AA meeting per se, just a presentation, though I think the session would end with the Serenity Prayer. I did not see one AA meeting there in July. I don’t think they have this anymore. Or at least they didn’t have Alcott patients going to these.
Describe the average day: The average day was very packed with activity. I never ran out of things to do and was never bored. They wake you up at 6am and do your vitals, and then you have to go get weighed out in the hall by the nurses’ station. Some chose to go back to bed but most stayed up and showered and got ready for the day. In the morning you also have to have meds (whatever you take, and vitamins) and also this was when they did blood work. You are only allowed 10 minutes in the shower women are no longer allowed to shower at night without a dr’s order, otherwise staff will get on your case or the other patients will hound you. Breakfast is at 8 or 8:30, can’t recall which, but often the trays would come up late anyway. Then groups…we had a morning meeting of sorts where they had announcements and we stated our “goals for the day.” Then a group or two and around 11 I think they had us fill out menus, which we all had to do together in the dining room. Anyone who had morning snack had to eat it at this time. Then more groups and at noonish, lunch. More groups came after lunch, and I believe the afternoon snack was at 3…then more groups and dinner. Occasionally, there was a half-hour break. There were also “fresh air” breaks but I never bothered to go, just didn’t want to, so I have no clue what those were like. In the evening there was a very short visiting hour, maybe an hour and a half (IT’S AN HOUR AND A QUARTER) each evening and that plus 2 till 5 on weekends. Then more groups. There was a snack at 8:30pm I think. Late night was generally free time for an hour if you were still awake, and then they made you go to bed. The schedule is pretty much still the same.
What were meals like? You sat in silence or played children’s games such as 20 questions, Outburst, Trivia, etc. These silly activities were supposed to keep our minds off the food. Meaningful discussion on any topic was immediately shut down by staff. You could only talk about…well, nothing of substance. Two staff people sit on either side of the room. Some of them sit and glare at you and some make friendly conversation so long as it’s on some mundane topic. Some joke around a little. I joked back and tried to make the best of things. This is the same but they have tightened it up. After meals, you have to sit and they inspect your tray. You raise your hand if you are finished and they see if you are indeed telling the truth. So the assumption is that you are lying until proven otherwise. Then, they excuse you.
What sorts of food were available or served? Standard hospital food, no frills. If I recall correctly, caffeine is allowed in the morning but at no other meal. Still true. There is no skim milk. NOW THEY HAVE SKIM MILK. You are required to drink whole milk or chocolate milk or soy milk if you ask very nicely. They also have that Lactaid stuff. There were very few vegetarian options and they were quite biased about turning you into a meat-eater. This is because the “food pyramid” and all those nutritionist people are monetarily backed by the meat and dairy racket. For snacks, anything fattening and junky they could get hold of for cheap they would make you eat. These included Nutri-grain bars, all sorts of sugary granola bars, Oreos, Lorna Doones, every kind of chip you can imagine, trail mix with chocolate and sweetened dried fruit, peanut butter, mozzarella cheese sticks, all kinds of crackers including Ritz Bitz, animal crackers, Cheese-Its, every kind of junk food you can imagine. You had to drink juice, milk, or sometimes a supplement with your snack. Note that they really don’t want the outside world knowing they feed their patients this stuff. But they make all kinds of justifications for it. They’ll tell you, “there is no ‘bad’ food, etc, and then turn around and tell you about ‘bad’ cholesterol, etc.
Did they supplement? How did that system work? Yes, they supplemented, usually with Ensure. They had a few flavors to choose from. When I was there in Feb 2012 they had changed the system a little. If you finished 100% of your meal, you could leave at the end of the meal. If you left anything, your tray was taken away and you were given a supplement and you had to stay an extra ten minutes to finish the supplement. This was the case for snacks as well.
What is the policy of not complying with meals? Again, if you didn’t finish it all, you were required to stay late. In practice, I’d say about 5% of patients actually drank the supplement. Most sat with it in front of them untouched, then the staff would have them pour it down the sink. Even if you say you don’t want the supplement, they will open it, stick it in front of you, and then have it go to waste. I finally told them that this gross waste of food was against my religion, so when I wasn’t going to drink the sugary fake food, I told them so, and they didn’t waste it. This time, they told me I was setting a bad example for everyone, so i complied, with a big toothy smile, what teeth I have left.
Are you able to be a vegetarian? Anything that goes against the American Dietetic Association’s all holy Food Pyramid, or whatever they have now that is based on corporate funding (Big Agriculture, drug companies, etc) is socially unacceptable in their eyes. So if you are a vegetarian they really push meat. If you are a vegan you are considered a sinner, and veganism is considered to be an eating disorder.
What privileges are allowed? I was only on inpatient. You are behind locked doors and have no rights. You have no privacy. All conversations are monitored, including those between patients, phone conversations made by patients to the outside world (the phones are out in the open and anyone can hear, though to my knowledge the phones aren’t tapped), and conversations with visitors during visiting hours. Some people are always, always monitored in the bathroom. You can shower alone. I was not monitored in the bathroom but they checked afterward to make sure I was peeing yellow and not something else. You have to get a doctor’s order for “fresh air break” but I don’t think that’s hard to get. There is no smoking. Patients got the patch often. When visitors came, they were given the nth degree and their things were taken away, including cell phones, pocketbooks, everything, while they were visiting you. Your shoelaces were taken out so it was best to have shoes with you that didn’t have laces. Also belts, any kind of drawstring, etc was taken away. Dental floss was not allowed nor were nailclippers. All this is now standard on any locked unit. Also, they no longer allow any yarn or any kind of knitting type thing. This was a huge change from 2010, when the whole unit was having a knitting craze.
Does it work on a level system? That I know of, all they had was the “band” system. You had to eat 100% for I think 48 hours and then when you went to the bathroom, they didn’t go look at your piss afterward. All bathrooms were always locked during the day but they did have them open from 6am until breakfast, and then after 9:30 at night. You were not allowed to brush your teeth after meals. We were told that thus taking care of dental hygiene was “eating disorders behavior.”Okay, the band system, in July, got to be this huge deal. I decided that it was actually a decent system, although it has no relevance whatsoever unless you do this “throwing up” behavior. So i do not throw up, therefore the band system did not apply to me. It did not provide incentive for me to eat or comply in any way. Nice idea, though. I have anorexia with binge eating and no throwing up (I have never been able) and their whole system went out the window in my case.
How do you earn privileges? Eat.
What sort of groups do they have? Besides the therapy groups I mentioned, there were goals groups, nutrition and other educational groups, etc. Every psych unit I’ve ever been on has called their last group “Wrap up,” and Alcott is no exception.
What was your favorite group? I’d say I liked most to sit and write by myself. They did encourage writing, lots of writing, but for the groups I’d say I liked being with adults only, when the younger people had their own group in another room.
What did you like the most? The other patients were the best part of being there. I was rather closed-minded about being stuck in there with kids, but as it turned out, the kids were awesome. People with ED’s rock!
What did you like the least? That’s hard to say. I guess after a while it seemed like I saw through the BS and the lies, and when I pointed out their inconsistencies and rights violations, they (the staff, that is) started treating me with disrespect. They began to deny that certain conversations had taken place, or that certain privileges were granted to me. I’d say the really good, quality staff who cared about the patients and didn’t see the place as just a paycheck really did treat me with respect, but that was only one or two of them. The head nurse is really the only one there who knows anything about ED. There are some staff who do not give a you-know-what. Also, they cannot handle serious psychiatric conditions there. I did not exhibit severe behaviors but I was suffering from severe psychotic paranoia while I was there. They did not recognize the paranoia. They didn’t know I was delusional.
I went to see my psychiatrist as soon as i got out, and she gave me a pill that cleared up the psychosis entirely. I had entirely quit taking meds and do not like taking pills, but I conceded, and sadly, agree that it is necessary. Paranoia is one of those things you can’t cure otherwise.
However, I did put in a human rights complaint based on fact that is, to date, at the state level. It is a follow-up to what I describe below, what happened in February:
The rest of them saw me as a crazed mental patient and just shook their heads at me and snickered or made faces, or ignored me. There was no communication between shifts. I haven’t a clue what was actually “passed on” in report except gossip about nail polish and hair styles. I had spoken to the Human Rights office a number of times and put in complaints these were about telephone rights, that is, right to a private telephone conversation, granted to us by the state of Massachusetts, and for some reason the staff always denied knowing anything about this and that these conversations hadn’t taken place and that the Human Rights person I spoke with didn’t exist, the room I was legally entitled to use didn’t exist, etc. Kinda funny cuz we had groups in that room.
Would you recommend this program? This is my opinion: if you have a choice as to where to go, get treatment in a state that has a Mental Health Bill of Rights. Some states do and some don’t. In Massachusetts, where Walden is, we have what’s called the Five Fundamental Rights and a strong patient rights legal influence. In other states, it is legal to stare you down while you poop or brush your teeth or shower, and listen on to your phone conversations or flat out refuse to let you use the phone. In Massachusetts, phone and privacy are rights, not privileges. I didn’t want these rights so that I could do any kind of eating disorders behavior, but so that I would be treated with respect and dignity, and feel like a human being and not an animal fattened up for slaughter. Also, you are entitled to speak with an attorney or clergy person at any time. In Massachusetts, they have to allow you a visitor at any reasonable time (they don’t tell you this, but it’s the law). So if your family can’t come during the extremely narrow visiting hours offered, just ask and legally they have to make arrangements for you. Some patients didn’t know this and were isolated from their families for weeks. I’d say that compared to other places I’ve heard about, Walden is about the same…they all take your life away.
In July, they tightened up their rules about the phones and made it worse and even more illegal. I put in another human rights complaint. The director of nursing, Celeste Cook, flat out refused to budge. I appealed and it was turned down. I was told back in feb that the phones were “inspected by the department of mental health and they are compliant with the law.” Well, this sounded fishy to me. Turns out DMH was never in there and this was a lie. I have been in touch with DMH myself. I have now taken this to the state level. I am determined to get this done, to have little sound-proofing walls built around these phones so patients can have private phone conversations, as granted by Massachusetts law. It is my mission, my gift to folks with eating disorders. I love you all.
What level of activity or exercise was allowed? Occasionally, yoga if the instructor wasn’t out sick or on holiday. But it’s very pared-down yoga with very little exertion, mostly breathing exercises. According to these so-called experts, exercise is “bad” for any ED automatically, even though it is proven to be more effective than drugs to help depression and sleep. Any exercise is reframed by these people as “overexercise.”
What did people do on weekends? About the same as weekdays except no “team” staff and more visiting hours. Some patients said they were bored. I just sat and worked on my writing all day long and was rather relieved to be left alone.
Do you get to know your weight? I pretty much could guess what I weighed, so I didn’t bother asking. It was rare for a patient to find out. I was a little vague on whether parents could find out their kids’ weight or if spouses could find out. I’m not sure about what the law says about spouses and parents having access to such medical information that the patient doesn’t even know.
How fast is the weight gain process? If you cooperated, 2-3 pounds per week. When I was in there in 2010 I gained 10 pounds in 16 days on the tube. Whether or not you get a tube depends on insurance and money. They don’t give a hoot about feelings.
What was the average length of stay? I’d say inpatient folks stayed about ten days, some stayed well over a month. Afterward, many went to “step down” programs. I did not have this opportunity due to the fact that I am on public insurance (i.e. I am poor).
What was the average age range? Teens and twenties mostly. At isolated times you might go there and find a bunch of people in their 40’s, 50’s, and up, though.
How do visits/phone calls work? None of these units follow the law unless you insist that they do. Know your rights! Otherwise, all your phone conversations will be overheard in the open hallway. I insisted that they allow my minister to visit at a time that was convenient to him and they said he could call them and make the arrangements. I insisted that they find a private place for me to meet with him. I believe the law grants this right. Telephone is a right, not a privilege in Massachusetts. Phones are on the wall and you can usually find a free one. Calls are free in the US and probably Canada as well on these phones. It is nearly impossible for anyone to get through to the patients on these phones, though, because either there is a group going on or no one can find you (or bothers looking). So if someone wants to talk to you and can’t get through, have them call the nurses’ station and work it out so that the call comes in while you’re standing right there to pick up. Another thing is that if someone calls, staff by law cannot even say that you are a patient there unless you give written permission for staff to acknowledge your existence on the ward. It gets very complicated and tough to deal with the phone situation. See above.
Are you able to go out on passes? You could get a pass to visit with your visitors in the hall under certain circumstances. Babies were not allowed on the ward and often this privilege was used for baby visiting. They now grant off-grounds passes sometimes.
What kind of aftercare do they provide? Do they help you set up an OP treatment team? If you leave ama like i did expect no aftercare arrangements. They are supposed to do this, and say they do, but don’t always. I saw people discharged with no aftercare, not even a therapist. In general, in Massachusetts if you have no place to live, they just give you a list of shelters and tell you to start making phone calls. My friend left with no place to live. Same with therapists. On public assistance, finding a therapist usually takes waiting on waiting lists for months. I have had no therapist since March. It is now September. I will finally have an appointment September 20. I have Medicaid and Medicare. The hospital did not help or make a single phone call. Once, they had a group lined up for me, and when I got out, the group fell through. Also, if you call them after you leave to ask a question, generally your call won’t be returned. They are no longer legally responsible for you. That’s reality. But if you have good insurance you can go to their residential, nicknamed the babyish name “Rezzie,” never quite got that, or you can go to IOP. They have just set up a new Binge Eating outpatient treatment program, some sort of IOP, that my insurance doesn’t cover.
I should also add that there was absolutely no treatment for binge eating while I was there. Of course, the food is locked up and you don’t do that behavior while you’re there, but they have no way of treating it and seemed to know nothing about binge eating. This is still true. No treatment for this behavior. I begged for help with it but all I got was about two minutes of advice from the nutritionist which was pretty much useless to me. They know nothing about medications for binge eating. I had to beg for one. It took six days of wasted inpatient stay to get started on the med. Only one nurse, the head nurse, knew this med existed. They would not give my friend meds for binge eating either. The nutritionists didn’t seem to understand the behavior and why people do it. I think they assume people binge because they are hungry, but we all know that it’s much more complicated and often, people binge eat when they are far from hungry. They really didn’t seem to care about how I felt about this behavior, and some didn’t understand and thought it was good to binge cuz then I’d gain weight.
I have asked about going back in and they said they had some kind of group for binge eating at night, but I had no clue if this was once a week or every night and if the group was any good. I don’t want to waste my time and show up only to find out there is still no treatment for it. I couldn’t get a straight answer from Admissions and every time I called, they told me something different. You really have to needle the Admissions people for answers because they won’t tell you stuff otherwise. Remember, all these people at these places are trying to sell their product and will often give vague answers to your questions. They do have some group but they did not take me to the group. It is not held on the inpatient unit. The staff knew nothing about binge eating. The doctors knew nothing. They only care about weight there. Only one nurse knows anything, the head nurse. Go to her for information. Unfortunately, it would take me days to get a conversation with her. In the end, the med they gave me bombed out anyway. I now take a low dose of a different med. I consulted my own shrink.
The doctor I had, who was a nurse practitioner, never, ever read my chart except one thing, my weight. She came in and asked the same stock questions every time. The doc i saw in july also did not read my chart ever. I challenged her and everyone on this and made a stink, but because she never read my chart she never found out that I complained about her. I could tell by her questions. She never read my blood test results, either. I put up a stink about having headaches and suffering from really bad thirst and insisted that she examine my blood work, and sure enough, I was dehydrated, and finally they allowed me as much water as I needed to keep my thirst quenched. I left kinda before planned because I was so fed up about the disrespectful attitude they had. I figured I was only getting worse being treated like a child. I was in dreadful physical shape the day I left and barely made it home on the bus.
This time, they ended up doing some tests on me and discovered some medical issues…can’t get into it without boring you. But I continue to deal with dehydration and kidney issues.
I have been in bad shape since leaving, and it has been months now with no hope. I haven’t had a therapist all this time, nothing, no family support either. I’m glad I have my church. See below for update.
Are there any resources for people who come from out of state/country? As I said above, get treatment in states that have patient rights laws. Know the law…it pays. Speak up for yourself and demand getting what you need. They do have a few good people at Walden so seek them out.
As I said, I was also treated on Thoreau for ED but this isn’t done too often. They will deny that they do this, but they do, they just don’t want it officially known. If you want to know more about that, please post and I’ll try to answer. Thoreau was a very positive experience for me, about the best psych unit I’ve been to in my opinion. Good luck and I wish everyone the best.
Update: I don’t know exactly step-by-step what happened, but now, my dog isn’t my “pet” anymore, she’s my service dog, and my life has changed around. I can say the following:
I got better in spite of treatment.
My life is now joyful. I am no longer engaging in behaviors at all. I am against forced care of any kind. I am against “the tube.” I believe these places are out to take your money and nothing else. If you get something out of it, great. If you are forced to go, make the best of it. Get better one way or the other. Eating disorders are not a good way to live. Joy is just around the corner. I would never have believed it. I’ll tell my story to anyone who wants to listen. I hope I never grow out of wanting to change the world. I was even in the local paper today.
Hey, guys, these places are ALL like this…I am against forced care of any kind.