Eating disorders affect more than 5% of young people, and they have one of the highest mortality rates of any mental illness.
Young patients with public health insurance have a much harder time accessing care, and they often get caught in a revolving door of hospital stays.
Researchers at UC San Francisco wondered if the cycle could be disrupted by giving outpatient therapy in the months after a first hospitalization. They examined data from 920 California Medicaid enrollees ages 7 to 18 years old who had been hospitalized with an eating disorder.
These young patients received on average just two outpatient therapy sessions after leaving the hospital; 45% received none at all. Therapy, when delivered, was provided by community-based clinicians rather than specialty clinics.
What they discovered
Those who received eight or more therapy sessions were 25 times less likely to be readmitted than those who received three or fewer sessions. Outpatient providers don’t need to be specialists or experts in eating disorders to help young people with these conditions stay out of the hospital.
California’s Medicaid program (Medi-Cal) would save more than $7 million annually in rehospitalizations alone if adolescents could access eight or more sessions of outpatient therapy after hospital discharge for eating disorders.
Why it matters
Hospitalization can be especially challenging for families on Medicaid. “Caregivers are more likely to be single parents with less flexible work schedules and fewer financial resources to cover out-of-pocket expenses,” said first author Megan Mikhail, PhD.
“The findings suggest a modest amount of outpatient therapy from any type of provider can help break the cycle of repeat hospitalizations,” said senior author Erin Accurso, PhD.
Publication: Pediatrics (July 25, 2025)
Other Authors: Amanda Downey, MD, of UCSF; Kate Duggento Cordell, PhD, of Mental Health Data Alliance; Lonnie Snowden, PhD, of UC Berkeley.
Funding and Disclosures: Accurso has consulted with Partnership HealthPlan of California. This study was supported by the Deb Family and a grant from the National Institute of Mental Health (NIMH K23 MH120347; ECA).