Back when I was a hospital accountant I applied for a position as an accounting manager at a chain of psychiatric hospitals. I did not pursue it beyond the first interview because something seemed off. A few months later the Dallas Morning News ran an exposé on the chain, which was accused of bilking insurance companies. At that time most health plans had limits on mental health coverage. The chain specialized in adolescent mental health problems and used scare tactics to convince parents to allow their kids to be admitted. Every case of teen angst was declared a suicide risk, requiring involuntary inpatient admission. Only kids with good insurance were at high risk, however. They were magically cured on the day insurance benefits ran out.
Acadia Healthcare is holding people against their will to maximize insurance payouts, a Times investigation found.Acadia Healthcare is one of America’s largest chains of psychiatric hospitals. Since the pandemic exacerbated a national mental health crisis, the company’s revenue has soared. Its stock price has more than doubled.But a New York Times investigation found that some of that success was built on a disturbing practice: Acadia has lured patients into its facilities and held them against their will, even when detaining them was not medically necessary.
How does this happen? Some patients showed up at an emergency room seeking mental health care only to find themselves involuntarily admitted. One woman wanted to get her bipolar medications adjusted and found herself locked up at an Acadia facility. Another woman went to an Acadia facility seeking outpatient therapy and was involuntarily admitted.
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.But at Acadia, patients were often held for financial reasons rather than medical ones, according to more than 50 current and former executives and staff members.Acadia, which charges $2,200 a day for some patients, at times deploys an array of strategies to persuade insurers to cover longer stays, employees said. Acadia has exaggerated patients’ symptoms. It has tweaked medication dosages, then claimed patients needed to stay longer because of the adjustment.
Almost any symptom can be interpreted to tip the balance in favor of additional therapy. Didn’t finish your meal? You must be depressed and need to stay another day or two or perhaps a week.
To make matters worse, the additional days of care weren’t necessarily beneficial. In many cases the extended stays were of no medical benefit and even harmful.
…health inspectors have found that some patients did not receive therapy, were unsupervised or were denied access to vital medications. Many inspection reports described rapes, assaults and filthy conditions.
Historically psychiatric hospitals were mostly run by the government. With few effective treatments patients could languish for years inside an institution. Government psychiatric facilities began closing in the 1950s and 1960s as better medications were discovered and patient advocates sounded the alarm that involuntary confinements were a violation of civil rights.
The Affordable Care Act beefed up requirements that health plans cover mental health care, and for-profit entities took advantage of this fact. As I wrote about in an earlier post, diseases of the mind are different than disease of the body. There are no objective standards for what constitutes a mentally healthy individual. This subjectivity provides plenty of room for unscrupulous psych hospitals to admit patients who don’t need inpatient care and exaggerate symptoms to keep patients there longer than necessary.
Aggressive marketing, outreach to law enforcement, outreach to emergency room doctors and hospital staff is a way to fill psych beds with referrals. Although inpatient psychiatric hospitals are sometimes needed in extreme cases, they are ripe for abuse. That’s the odd nature of mental health care.