How a Leading Chain of Psychiatric Hospitals Traps Patients

A big problem is that people receiving psychiatric care often can't get justice in court. Who is the jury, or judge, more likely to believe, someone who needed psychiatric care, or a credentialed doctor?

I know someone who was threatened with having their children taken away, and prison if they tried to leave the hospital, or stopped taking medication that was making them feel worse.

But since it was just the doctor's word against theirs, they were told there was very little chance of winning in court.

This story is an incredible illustration of incentives gone wrong.

The affordable care act mandated that insurance companies cover mental health. Psychiatric hospitals can charge insurers $2,200/day for holding patients who "pose an imminent threat to themselves or others".

So now you get this:

> Once Acadia gets patients in the door, it often tries to hold them until their insurance runs out.

> Acadia goes to great lengths to convince insurers that the patients should stay as long as possible, often around five days.

> To do that, Acadia needs to show that patients are unstable and require ongoing intensive care. Former Acadia executives and staff in 10 states said employees were coached to use certain buzzwords, like “combative,” in patients’ charts to make that case.

Rare instance of good journalism. More people need to know about this company that commits heinous crimes

I'm not anti-psychiatry per se, but I always keep in mind that every industry has perverse incentives to not lose their customers. Every once in a while, a professor or journalist checks themselves into a psychiatric hospital with some temporary fake symptoms, then behaves perfectly healthy, but are unable to escape without a lot of outside intervention. E.g. https://en.wikipedia.org/wiki/Ten_Days_in_a_Mad-House (1887), https://en.wikipedia.org/wiki/Rosenhan_experiment (1973) .

A friend of mine was on screwed in the other direction here in California.

When stable, they signed over the right to commit them to me, their doctor, their spouse and their parents.

We all attempted to get care for the person during a psychotic break (including talking about plans to shoot up a religious gathering - the police wouldn’t do anything even after that).

As a result, they lost their job, marriage, apartment, possessions, life savings, and ended up $100K in debt.

The insurance company didn’t pay a dime when they finally got help, since coverage had already lapsed.

I can’t believe how broken healthcare is in the US.

Do the patients ever use the phones from these facilities to call the local police departments about being held against their will without cause? At this scale seems like that should happen.

  Most doctors agree that people in the throes of a psychological crisis must sometimes be detained against their will to stabilize them and prevent harm. These can be tough calls, balancing patients’ safety with their civil rights.

IMHO it's acceptable sometimes to balance others' safety with a patients' civil rights. But it's not acceptable to trump someone's civil rights with concerns about their own safety. That balance can certainly result in tragedy when people make horrible choices. But it preserves the concept of civil rights against the incompatible alternative of overruling them in the name of safety. We can't get the benefits of freedom by only allowing "good" choices, because those benefits flow largely from learning from the bad ones. We are very capable of collectively making bad choices (from slavery to lobotomies) and defining them as good. Civil rights are a way to counterbalance those.

It's sad that this information is behind a paywall. Not as a fault of the New York Times, they deserve money for this work.

It's sad that the default freely available information spread around is that the chain of hospitals is a professional institution that's endorsed by the board of medicine. And knowing the truth costs money. Just as bringing these folks to justice costs money.

Highly recommended movie watch:

Unsane.

This is an industry wide practice for decades across every segment of the healthcare sector.

Take note that all these victims were either employed or had insurance coverage. It's telling that they're not targeting the local homeless individual for 'care.' Which makes this more disgusting.

Prisons and psychiatric care provide compelling examples of the boundaries of for-profit models and why they might not always be the best solutions in an area. You can always argue — reasonably I think — that these cases represent anomalous bad apples but I think as long as that incentive structure is there it will pull for this kind of thing at some level, even it's not quite as extreme as this example. I think that profit incentives and lack of competition tend to distort healthcare across all sorts of specialties in much more subtle ways than what was going on at this hospital chain. When threats to personal autonomy start to become the consequence it seems to clarify some of the problems involved, but the same processes are at work in all sorts of areas.