Two Brattle Center: A Mental-Health Clinic in Search of a Viable Operating Model

Two Brattle Center (TBC) is a struggling for-profit private mental health clinic based in Harvard Square. Its founder, Dr. Joan Wheelis, is a nationally recognized practicing psychiatrist who has developed outpatient treatment programs based on Dialectical Behavior Therapy (DBT) for patients with borderline personality disorder (BPD). These patients, typically adolescent girls and young women, struggle with emotional crises and are prone to destructive behaviors such as cutting, excessive use of alcohol, taking drugs and suicide attempts. These patients are very difficult to treat and TBC has developed programs that make a noticeable difference to these patients. DBT requires teams of people with different types of expertise and so the original operating model developed by Dr. Wheelis was one in which TBC was staffed by a large number of part-time clinicians, the "affiliate model." However, changes in the health care environment, particularly the advent of managed care, have put very real