For seven years, Lisa Sabey went to bed at night afraid that she would wake up and find her only daughter dead.
Despite weekly therapy sessions and stays at four residential treatment centers, Sabey's daughter wasn't recovering from anorexia nervosa, the most deadly eating disorder. The teen was depressed and suicidal; her mother, frustrated and scared.
Eventually, Sabey found a treatment center in Ohio that helped her daughter, but before then, her frustration turned to anger.
And instead of privately railing against a mental-health system that was failing her family, the mother of six decided to make films about it.
On Thursday at the University of Utah, Sabey's second documentary, "Going Sane," will be shown at 7 p.m. at the A. Ray Olpin University Union. The film, which Sabey produced and one of her sons wrote and directed, is the culmination of a year of research about a mental-health system that, Sabey charges, discourages family involvement in treatment and often values profit over outcomes.
“Ever since Freud, there’s been a belief that families are part of the problem when there is mental illness,” said Sabey, who lives in Denver. That mindset can result in treatment where children are seen behind closed doors for weeks or months, with little to no involvement with parents and other family members.
“We have decades of research that indicate that when you include family, you introduce skills to help the individual outside the therapy office," she said. "And if you’re not understood and helped outside of the therapist’s office, you’re not going to be able to overcome whatever mental illness you have.”
While Sabey said the film is intended to inform and empower parents regarding mental health treatment for their families, she also makes a sweeping indictment against the therapy profession. Sabey said the industry generates more than $200 billion a year and charges that the most prolific treatment centers in the country hire more marketers than licensed clinicians. She also claims that a majority of therapists are not using evidenced-based techniques, resulting in many families losing time and money on unproven therapies offered by counselors with limited education.
“Lots of people hang their shingles out who should not have shingles hung,” Cynthia Bulik, a clinical psychologist and founding director of the University of North Carolina Center of Excellence for Eating Disorders, says in the documentary.
'Parents need to know this'
Sabey’s journey from stay-at-home mom who occasionally taught Chinese at the local high school to documentary filmmaker and patients' advocate began when her only daughter was 12 and suddenly seemed to stop eating.
Sabey and her husband took the teen to therapists every week and even enrolled her at residential treatment centers, to no avail.
“She got more and more distant and closed with us; we were absolutely baffled and confused,” said Sabey, who is 56. “After she ended up leaving our family and our faith, I turned to research and I realized that after seven years of weekly psychologists, none of them used treatments that were evidence-based for anxiety, anorexia and depression. How can that happen?”
For people with anorexia nervosa, a type of therapy called family-based treatment (or FBT) is widely considered effective, yet therapist after therapist saw Sabey’s daughter behind closed doors, and her parents were not included in the treatment, Sabey said.
The Sabeys’ frustration with the mental-health treatment their daughter received is not unique. In a joint study, researchers at Brigham Young and Emory universities found that therapists vastly overestimated how much they helped their patients. In the study, therapists said 91 percent of patients improved under their care, but when patients were interviewed, only 42 percent said they had improved, 50 percent reported no change and 8 percent said their condition had deteriorated.
The Sabey family eventually found a family-based treatment center in Ohio that helped. Sabey’s daughter recovered and is now 24 and preparing to get married. Meanwhile, her mother is on a crusade to help other people as frustrated as she was.
“Parents need to know this,” she said. “And this is not just about anorexia. This is about the mental-health field.”
The people interviewed in the film include William Pelham Jr., director of the Center for Children and Families at Florida International University; National Book Award winner Andrew Solomon; and Erin Parks, director of outreach and admissions for the Eating Disorders Center for Treatment and Research at the University of California-San Diego.
Parks, who did not know Sabey prior to contacting her after seeing her first film (“Anorexia: What We Wish We Had Understood,” released in 2014), attended the premiere of “Going Sane” in Denver April 21. She hopes the film gets wide exposure because of its potential to help parents, but acknowledges that some mental-health workers would be upset by it.
“I wouldn’t be surprised if half the industry is upset about it,” she said, noting that most people enter the field “for the right reasons,” but whether for lack of training or other reasons, aren’t using the most current, scientifically proven treatments.
In her own specialty of eating disorders, for example, Parks said that there is “zero evidence” to suggest that parents are to blame for eating disorders; instead, the more parents are involved, the more likely the child will get better, she said. Despite this, many therapists persist in approaching eating disorders from the perspective of the child’s parents being responsible, Parks said.
A tool for families
An "evidence-based" practice is simply one that uses science to inform the treatment, which has been tested first in clinics, then out in the world, said Bulik, the distinguished professor of eating disorders at the University of North Carolina at Chapel Hill Medical School.
It sounds like a reasonable standard of care, but in fact, “You can get a license (to be a therapist) without ever having learned an evidence-based treatment,” Bulik said. As such, some people advertise mental health services that are little more than “unconditional positive regard and gentle suggestions."
“You don’t know what happens behind closed doors when someone is in psychotherapy,” Bulik said.
Vaile Wright, a licensed psychologist and director of research and special projects for the American Psychological Association in Washington, D.C., has not seen the documentary but is concerned that too much criticism of the mental-health industry might lead some people not to seek the care they need.
“That’s still suggesting that about a third of individuals aren’t getting better; there’s room for improvement. But like physical health, not everybody gets better,” Wright said.
Like Sabey, Wright believes that families need to be smart advocates for a patient’s care. Ask the provider about his or her credentials and licensure, the approach to treatment, a timeline for change and what a positive change would look like, Wright suggests.
She also advises that parents and patients ask, “What are you going to do if in 10 weeks we haven’t seen a change?”
Following the hour-long film, Sabey, other parents and mental-health professionals will field questions from the audience. The event will be from 7 to 9 p.m. Thursday at the university union, 288 South Central Campus Drive, Room 255, in Salt Lake City.
Other public showings are in the works for San Diego, Raleigh, North Carolina, and other locations, and people can also view it for $2.99 online at goingsane.org.