Psychiatric Hospitals: Leading The Way In Mental Healthcare

A recent investigation by the New York Times has revealed a pattern of unsettling practices by one of America's largest chains of psychiatric hospitals, Acadia Healthcare. The investigation found that Acadia has lured patients into its facilities and held them against their will, even when it was not medically necessary. In at least 12 of the 19 states where Acadia operates, dozens of patients, employees, and police officers have alerted authorities that the company was detaining people in ways that violated the law. This has led to concerns about the role of for-profit companies in the psychiatric care industry and the potential for psychiatric coercion when motivated by financial gain.

Profit motive and lack of quality care

The current psychiatric hospital care model has been described as being in crisis, with a lack of appropriate measures to effectively assess care quality. This has resulted in a critical missed opportunity to improve patient outcomes. One of the root causes of this crisis is the financial incentives of the system, which do not encourage significant changes or improvements. This is further exacerbated by the profit motive of many psychiatric hospitals, which has been criticised for prioritising revenue over patient care.

A notable example of this is Acadia Healthcare, one of America's largest chains of psychiatric hospitals. Since the pandemic, Acadia's revenue has soared, with its stock price more than doubling. However, a New York Times investigation revealed that this success was partly due to the company's practice of detaining patients against their will, even when it was not medically necessary. This disturbing practice has been reported in at least 12 of the 19 states where Acadia operates.

The profit motive in psychiatric hospitals can lead to a range of issues, including understaffing, a lack of expertise among administrative leadership, and a focus on maximising charges and profits rather than equity and quality. This can result in higher costs, the skimming of patients who can pay, and the neglect of those who cannot. In one tragic incident, Acadia was faulted for falsely claiming that a patient in Memphis had been checked on regularly, only for the patient to be found in rigor mortis hours after his death.

The issue of profit motive is not unique to Acadia, with other chains of psychiatric hospitals, such as Steward Healthcare, also facing criticism for their practices. A study on the effects of proprietary management in psychiatric units found that while some improvements were made under outside proprietary firms, such as higher staffing levels and more training, there were still concerns about the impact on patient care. The study cautioned against generalising these findings due to the small sample size.

To address these issues, there has been a paradigm shift towards community-based care, aiming to balance mental health care between community and hospital services. This approach prioritises providing care near or at people's homes, reducing the economic burden of hospital admissions while improving patient satisfaction and quality of care. However, inadequate community psychiatric care can lead to increased institutionalisation and health costs, underscoring the need for strengthened community care systems and professional training that emphasises community care.

Overriding medical orders

In the context of psychiatric hospitals, overriding medical orders typically refers to instances where individuals are hospitalised or detained against their will due to being deemed a danger to themselves or others. This process is often referred to as involuntary confinement or civil commitment and requires judicial permission unless the situation is deemed an emergency.

In the United States, the laws governing involuntary commitment vary by state. For example, in Massachusetts, patients with serious advanced illnesses can discuss completing a MOLST (Massachusetts Medical Orders for Life-Sustaining Treatment) form with their clinician. This form allows individuals to relay their wishes regarding life-sustaining treatments, including resuscitation orders (DNR). In Quebec, Canada, individuals can be forcibly hospitalised for up to 72 hours without a court order if they present an immediate danger to themselves or others due to their mental state.

The decision to involuntarily commit someone is typically made by mental health professionals and is based on a combination of the individual's values, preferences, and medical facts. In some cases, as highlighted by a New York Times investigation, patients have been wrongly detained by psychiatric hospitals, even when it was not medically necessary. This has raised concerns about the practices of for-profit psychiatric hospital chains, such as Acadia Healthcare, and the potential prioritisation of revenue over patient care.

To ensure the protection of patients' rights, individuals subject to involuntary commitment have certain entitlements. These include the right to be informed of the reasons for their confinement, the right to legal representation, and the ability to challenge their forced hospitalization. Additionally, treatment plans should be provided, and patients should be informed of their right to apply for leave to spend time outside the facility, enhancing their recovery and reintegration into the community.

Poorly trained staff

The impact of insufficient training is further exacerbated in for-profit psychiatric hospitals, where the focus on financial gain can compromise patient care. In the case of Acadia Healthcare, there have been numerous reports of patients being held against their will to maximize insurance payouts. This practice has led to patients being detained longer than medically necessary, with Acadia exploiting legal loopholes by filing petitions to extend patients' involuntary stays.

The issue of poorly trained staff in psychiatric hospitals is not limited to individual incidents or specific hospital chains. It reflects a broader trend within the mental healthcare industry. A former employee of another psychiatric hospital chain shared their experience, highlighting that patients often did not receive therapy, including group therapy, and that individual therapy was practically non-existent. This lack of therapeutic intervention is attributed in part to insufficient staffing and a profit motive that prioritizes financial considerations over patient care.

The impact of inadequate training and staffing extends beyond the denial of therapy. Health inspectors' reports from Acadia facilities revealed concerning findings, including patients being unsupervised, denied access to vital medications, and subjected to filthy conditions. These issues contribute to a culture of mistreatment and neglect within psychiatric hospitals, where patients' voices are often dismissed due to the stigma associated with mental illness.

The consequences of poorly trained staff in psychiatric hospitals can be dire, as illustrated by an incident in Tennessee involving Acadia. Inspectors found that Acadia falsely claimed in medical charts that a patient in Memphis had been checked on every 15 minutes. Tragically, the patient was found in rigor mortis hours after his death, indicating a significant lapse in proper care and supervision. This incident underscores the critical importance of adequate staff training and oversight in psychiatric hospitals to ensure patient safety and well-being.

Involuntary treatment

The World Psychiatric Association developed a code of ethics for clinical practice in 1977, named the "Declaration of Hawaii". The WHO recommends that hospitalization durations should be limited to the risk posed and used only if there is no other way for the patient to receive treatment. The European Convention on Human Rights (ECHR) provides that forced hospitalization should be in the context of prohibiting any inhuman or degrading treatment.

In the United States, Acadia Healthcare, one of the country's largest chains of psychiatric hospitals, has been accused of detaining people in ways that violated the law, including holding patients against their will when it was not medically necessary. This has led to intervention from judges and authorities in several states.

Maximising insurance payouts

A New York Times investigation revealed that Acadia Healthcare, one of America's largest chains of psychiatric hospitals, has been holding patients against their will to maximise insurance payouts. This practice has contributed to the company's soaring revenues and stock prices, doubling since the pandemic exacerbated the national mental health crisis.

Acadia has been accused of luring patients into its facilities and detaining them even when it is not medically necessary. In at least 12 of the 19 states where Acadia operates, there have been reports of unlawful detainment. To extend patients' stays, hospitals require court approval. However, Acadia's North Tampa Behavioral Health Hospital in Florida exploited a loophole by filing petitions to extend patients' involuntary stays. From 2019 to 2023, North Tampa filed over 4,500 petitions, allowing them to legally hold patients and bill their insurance until the court date. Judges granted only about 1% of these petitions.

Acadia has also been criticised for falsifying medical records to justify continuing patients' stays. In 2022, Tennessee inspectors found that Acadia falsely claimed a patient in Memphis had been checked on every 15 minutes, when he was actually found in rigor mortis hours after his death. Additionally, employees at Acadia hospitals in Ohio and Michigan reported that doctors had written false statements in patients' charts. Acadia employees have also been instructed to avoid adjectives like "calm" and "compliant" in patients' charts.

Furthermore, Acadia has been known to deny patients access to therapy, supervision, or vital medications. Inspection reports have described rapes, assaults, and filthy conditions within Acadia facilities. Unless patients or their families hire lawyers, Acadia often holds them until their insurance runs out. This practice of maximising insurance payouts comes at the cost of patient safety and well-being, highlighting the delicate balance between patient rights and psychiatric emergency care.

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