Involuntary commitments to psychiatric facilities have increased over the last decade. Evidence indicates many are unlawful detainments, but facilities bill patients and their insurance providers.
A disturbing new exposé, published in the New York Times, sheds light on psychiatric facilities that admit and hold people against their will without any valid reason under the law, billing patients and their insurance providers for unnecessary, unwanted confinements that can traumatize detained individuals.
The Times investigation focuses on Acadia Healthcare, one of the largest chains of for-profit behavioral health facilities in the U.S. Medical records and interviews with patients and past and present employees appeared to show that many patients did not meet the criteria currently set by law that allows people who are an imminent danger to themselves or others to be involuntarily committed to a psychiatric facility. “Acadia has lured patients into its facilities and held them against their will, even when detaining them was not medically necessary,” the Times reported.
Insurance billing was maximized by using various excuses to claim patients needed to stay longer, often holding them until their insurance ran out, according to current and former Acadia employees interviewed by the Times. Acadia reportedly charges as much as $2,200 a day for some patients. With the bulk of Acadia’s revenue coming from government insurance plans, including Medicaid and Medicare, taxpayers are footing the bill for most of these unlawful detainments. This year, Acadia reportedly has tentatively agreed to settle U.S. Department of Justice allegations that include billing for unnecessary patient stays.
One of the Acadia psychiatric facilities mentioned in the New York Times article, North Tampa Behavioral Health Hospital, was the subject of a 2019 investigation by the Tampa Bay Times, which found that the facility illegally cut patients off from their families, held them longer than legally allowed, and ran up their bills while the confined patients were unable to fight back.
Acadia is not the only behavioral health company accused of billing government insurance plans for unlawful involuntary patient stays. In 2020, another of the largest U.S. for-profit chains of psychiatric facilities, Universal Health Services, agreed to pay $122 million to settle Justice Department allegations that included billing for medically unnecessary inpatient admissions and failing to discharge patients when they no longer required inpatient care.
It is estimated that over half (57%) of admissions to psychiatric facilities in the U.S. were involuntary – 16% came via the criminal justice system and 41% were civil commitments, a figure that rose by 27% over the last decade.
The increased risk for suicide in the period following discharge from psychiatric hospitalization is well recognized, but people admitted to a psychiatric facility against their will are even more likely to attempt suicide after discharge.
In a 2017 report, the UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health called for the elimination of nonconsensual mental health treatment, stating: “Coercion in psychiatry perpetuates power imbalances in care relationships, causes mistrust, exacerbates stigma and discrimination and has made many turn away, fearful of seeking help within mainstream mental health services.”
In 2019, the Council of Europe (COE) adopted a resolution that called on its member nations “to immediately start to transition to the abolition of coercive methods in mental health settings.”
More recently, the World Health Organization (WHO) issued guidance in 2021, advising countries to end coercive mental health practices, which it said are used “despite the lack of evidence that they offer any benefits, and the significant evidence that they lead to physical and psychological harm and even death.” The WHO guidance extends its call for prohibiting coercion even to those in mental health crisis.
Explaining its stand, WHO states: “People subjected to coercive practices report feelings of dehumanization, disempowerment and being disrespected. Many experience it as a form of trauma or re-traumatization leading to a worsening of their condition and increased experiences of distress.”
“CCHR is committed to ending the human rights abuse of coercive practices in the mental health system, including the incarceration of patients for profit,” said Anne Goedeke, president of the organization’s National Affairs Office.