Intake – American's largest psychiatric chain(buzzfeed.com) |
Intake – American's largest psychiatric chain(buzzfeed.com) |
That's terrifying. Earlier in the article they talked about people coming in for simple depression screening based the hospital's ads, but things like locking the doors behind people who choose to come in are probably keeping a lot of people from getting the help they need.
Medical care, especially medical care with an involuntary component, should never be for profit. The profit motive is just too corrupting.
Maybe it's currently reading Larsson's books, but mental health issues seem to raise incredibly challenging ethical questions (under economically feasible settings).
I've not heard anyone denying this. The only thing people like to debate is which aspect - as if it were a binary choice.
(For instance, say there is a doctor who gets paid in proportion to the time they spend treating patients at a non profit facility)
This is colloquially known as "whataboutism".
The fact that there are other pernicious motives is completely irrelevant. For-profit medicine constitutes a pernicious motive -- that's the point.
I remember vividly when my grandmother was in an awful hospital in NYC dying, I found the hospitalist to talk about her situation. He claimed to not Treating her and had no idea who was and directed me to another doctor. Yet he was standing at the station, with my grandmother's chart open with marking that he had just added her condition.
He actually told me the truth, but he was sitting there with a stack of files defrauding Medicare. Whatever profit the hospital was or wasn't making, the doctor was ringing his till.
That may be, but -- as other commenters have noted -- the definition of "for profit" is colloquial and subject to concept creep. A more specific prescription (heh), I think, would be that medical care (or at least involuntary care) should never be subject to fiduciary duty in the sense of Dodge v. Ford.
I'm glad that I was able to get appropriate treatment (15 years later) but how I was treated as a teenager in a mental health facility was atrocious. Misdiagnosis, over medication, and only keeping patients as long as their insurance held out was par for the course.
This was my experience as well. When I was in holding, a sympathetic nurse told me that to get out of there as soon as possible, I needed to smile, go to all meetings, and do exactly as I'm told. There was a Bible study that I wasn't interested in going to, and another nurse heavily suggested that I attend, which I ended up doing. I felt very powerless throughout it.
...
In the 1970s, a researcher sent fake (healthy) patients to asylums. They were loaded with powerful antipsychotics and not allowed to leave until they faked the cures the psychologists expected to see.
When the fake patients were all out the story blew the lid on the American psychological profession, so the psychologists said "bring more fakes, we can sort them out."
The original researcher said "sure."
The psychologists proudly stated a few weeks later that they had weeded out several dozens of "fakes."
There was no second fake cohort.
All joking aside: so far they've done good work and I assume it is earnest.
But I see your point.
> Two dozen current and former employees from 14 UHS facilities across the country told BuzzFeed News that the rule was to keep patients until their insurance ran out in order to get the maximum payment.
Coincidentally, I was discharged this morning from a psychiatric hospital in Canada. In a non-profit system, there is no financial motive to keep patients longer than necessary. Furthermore, hospitals in Canada almost always operate at capacity to keep costs low. This is a double-edged sword of course, but it means doctors have an incentive to help their patients recover so they can be discharged to make room for new arrivals.
I had a swimming instructor who told me her brother was mentally ill and was in and out of these all the time. He'd feel he'd need to stay there a few more weeks, but they'd push him right out. He'd do okay for a while, then stop taking his meds (because most of those meds do make you feel like shit), then he'd start having delusions again.
Eventually he'd be back to begging for 40ozs and eventually be back in the center. America's system doesn't provide enough funding, not just for mental health, but all the other services around health to help people out and be self sustainable in their communities.
Unless we (as a society) can find a way to provide this for those who have been pushed to the fringes of reality, there will still be a significant portion of people pushed into the Treat-Release-Repeat loop for years to come.
If you feel like you're in a bad place I encourage you to call your local university. Even if you aren't a student: schools are extremely used to dealing with people who don't know how to get started with the mental health (or any health) industry and they won't fucking kidnap you.
[1] http://shac.unm.edu/ they accept any one by the way. Please look for help if you feel like everything is awful, even if it's just finding some one to talk to.
Personally, I think a majority of the mental health industry is a fraud. These are the same people who voted that being LGBTQ is a mental illness in the DSM. :( Plus they don't even have blood testing like the majority of doctors can use as a test.
Then they over diagnosed kids and drug them, as a result of the one size fits all and boring education system - which promotes testing and memorization over charter and critical thinking.
Locking the doors behind people coming into the hospital voluntarily? I wish they were making this up.
I hope I remember not to go there in a crisis.
First a horror movie about false involuntary admittance.
Second, a fantastic corporate drama ala michael clayton about the corporate hierarchy that built, runs and protects the machine.
If anyone writes the screenplay for these, I want royalties.
In October 2016 I found videos of my friend before the first hospital. She quipped about alcohol and drugs, but sounded "normal". We were frying donuts.
About two weeks after the videos were filmed, my friend ran out of alcohol. Her mother called the "crisis team", who took her to the hospital. I don't know what happened, exactly, but I assume they treated her with Haldol, an old cheap "tranquilizer" that is sold to patients as an "anti-psychotic".
But... It's been known since the late 1970's that anti-psychotics make psychosis worse over time. Robert Whitaker wrote "the case against anti-psychotics" [1] to provide as succinct a case against this class of drugs' use as possible.
[1] https://www.madinamerica.com/2016/07/the-case-against-antips...
After being given this psychosis-provoking drug, my friend was diagnosed as "persistently disabled." This diagnosis (professional opinion) is disproved by my videos, but these have never been viewed by any judge.
Anti-psychotics are also known to make cocaine users more likely to use cocaine, which is known to cause psychosis. Alcohol withdrawal is also a known cause of psychosis [2]. My friend told the psychiatrists that she'd been drinking 2 bottles of liquor a day (methadone side effect, I think), and using cocaine, but they gave her anti-psychotics anyways.
[2] https://en.wikipedia.org/wiki/Substance-induced_psychosis#IC...
My friend escaped briefly from her court-ordered medications in March 2016.... Then she was given an SSRI "anti-depressant" in May 2016, which caused much anxiety, which led to her getting arrested... She's now being forced to take tranquilizers again.
I'm still trying to protect my friend from her doctors. When a petition to the court is dismissed "without prejudice" it means that you can correct the errors and re-file. I've re-filed twice, but I don't think the judge even read the second and third petitions. I guess I'm going to the court of appeals next... <sigh>
edit 1: clarification... edit 2: added the paragraph about getting ordered by the court to submit to psychiatry. edit 3: added sentence about the third world
edit 4: Oh my... This buzzfeed article is about "Universal Health Services". My friend stayed at two of their locations: http://www.uhsinc.com/locations/uhs-facilities-map-usa/
edit 5: I actually went to talk to an investigator with the state attorney general's office this morning - his department was "health fraud and abuse". He was not optimistic of being able to find something to investigate. I'm going to print this buzzfeed article and take it over.
edit 6: forgot to include link for [1]
One of the first films I ever watched with my Dad was "One Flew Over The Cuckoo's Nest" partly because it's part of his life history (grew up in Pac Northwest, ran into Ken Kesey a few times) but also because of the amazing life lessons within. The book is even more epic and deep. And, growing up in the US, I know mental health is still not quite up in the priorities as much as, well, look at commercials, there's a glut of dick-pills for sale.
I'm a proponent of using fiction to help re-package heavy, important lessons that journalism brings up. I'd written a short treatment years ago about a serious PhD Psychiatry student discovering most everybody in the "profession" at his Public/Private Treatment Center suffered from their own DSM-diagnosable serious mental illness. From macabre understanding we're all flawed might come enlightenment. Or, you know, just comedy.
https://thedianerehmshow.org/shows/2016-11-29/the-debate-ove...
Don't worry, free-market ideologues will coolly tell you. Their logic will seem airtight: over time, if Intake's psychiatric wards were really, truly locking up sane people who don't want to be locked up, the reputation of these facilities would no doubt have already suffered by now, and the company would have already been forced to close them. These incidents can only be isolated cases, regardless of the evidence. The profit motive will keep the company in check.
If you believe that, you haven't read the article.
Early in the article the author writes "Current and former employees from at least 10 UHS hospitals in nine states said they were under pressure..."
However, a few paragraphs later she writes "But scores of employees from at least a dozen UHS hospitals said those facilities tried to keep beds filled even at the expense..."
I don't understand why the employees are from "at least" a certain number of hospitals, unless her sources were unclear about where they worked. And why does this number change?
It shouldn't be, because doctors should have the sense and motivation to differentiate a joke from a true statement.
It's just a really sad statement that our society has traps like this (that people really need to be aware of), which can really screw you over.
Also, I understand the aversion many people have to even the concept of asylums, but the problem is in the implementation, not the concept. De-institutionalization is great, asylums should be an absolute last resort and many cases can be more easily dealt with in out-patient care or medication. But, absolute de-institutionalization means the mentally ill wind up homeless or in prison.
Things are much better (if only because all those big institutions were closed), but we stills see examples.
http://www.independent.co.uk/news/world/americas/woman-held-...
This woman told her doctor that President Obama followed her on Twitter. That's very easy to check, 5 minutes tops. No one checked, they assumed it was a delusion, and she was detained against her will, deprived of her liberty.
The submitted article has some really disturbing parts:
> A technician rifled through Trimble’s purse for sharp objects and then a nurse told her to strip down to her underwear. It was then, she said, that she realized the doors to the psychiatric ward had locked behind her.
> Trimble, who has recently reached a settlement regarding her hospitalization, recalled shaking with fear and “deep, shameful humiliation” as the nurse examined her body, noting the location of any identifying marks. “All you can do,” Trimble said, “is stand there and let it happen.”
There's considerable overlap between "people who've experienced abuse" and "people who have mental illness". You can imagine jut how traumatic this kind of treatment could be to some people.
> Current and former employees from at least 10 UHS hospitals in nine states said they were under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out.
This is bizarre. There's no shortage of people who would have an actual need for those beds.
The article even indicated this:
Current and former employees from at least 10 UHS hospitals in nine states said they were under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out.
An anarco-capitalist (an anti-rand) libertarian flavor) rejects involuntary commitment as a matter of dogma. So these institutions cannot exist, even if they are following the "law".
Furthermore it is the state who has monopoly over violence that legitimizes this behavior (the history of physiology, involuntary commitment, and state violence is rich and fascinating).
Libertarians see this as violence over an individual. Not being the initiator of the violence, the victims have a full moral right to use violent means to defend themselves, up to and including deadly force.
Right or wrong, these "free market extremists" have a more nuanced position than "the market will sort it out"
However, it seems clear that pressure to profit, pressure to grow fast, to raise ever larger rounds, etc. leads to huge missteps, both in tiny startups and in huge corporations. If you replace "beds" in that quote with "bank accounts" you get the Welles Fargo scandal. Ditto for Theranos. And these are only the very recent examples (that we know of).
I've been in and out of various psychiatric facilities, including that very same facility in Arlington, and it seems like a lot of the policies & procedures are to cover themselves legally.
Oh, I've been there as a Paramedic, not as a patient. Almost forgot that bit. We typically bring people in the front door. Even voluntary admissions. The one thing that struck me as odd is that Millwood always has someone (a LCSW or something) come out and talk to patients there in the lobby some before having them sign any of the admission paperwork. They don't lock you in a room and then have you sign.
I'm confused, are you complaining about psychiatrists forcing medication on people? I thought the entire point of seeing a psychiatrist was to get on medication...
It doesn't mean that what was said was the actual reason, which happens to often. Not enough follow-up happens, and the original trigger for the call-for-help goes unaddressed.
IMO Matthew Salanger should be facing down charges carrying hard jail time right now.
Insurance covers on average two sessions of therapy annually.
Therapy is only effective over long periods (years) of regular (weekly/biweekly) sessions.
It's a fucking travesty.
I spend close to $500 per month, after insurance, for my mental healthcare. This is a therapist and a psychiatrist.
None of this is covered by my insurance.
I pay what I can with an FSA but it's extraordinarily exhausting.
Some crimes don't have a legal victim, e.g. murder (victim is dead) or so-called "victimless" crimes (prostitution, drug possession, speeding, etc).
http://app.leg.wa.gov/RCW/default.aspx?cite=9A.40&full=true
I suspect If I kept google-ing danger to self or others gives institutions authority to restrain.
I for one think it is very important that any attempts to prevent this behavior don't leave loopholes for non-profit hospitals, so keeping this in mind here is actually very important.
So my point is that you need external controls regardless of the motivations of the actors inside the institution.
It seems that they aren't the only difficulties you have. In a social health-care system, possession of a medical license doesn't entail one's employer. You're more than welcome to set up private practice, though you'll have less chance of the career defining cases, as the majority of patients will not be using your one-man-band practice. Thus many doctors in the UK, split their time between their private practice and public services. The only thing that's "de-facto" is the need to be qualified to treat people.
Doctors are still very well-paid in France, for instance. It's just that the hospital isn't expected to turn a profit.
They are both economic benefits from providing a valued product or service. Saying that the one is evil while ignoring the other doesn't make any sense at all. It's the opposite of being beside the point.
Take the case of 2 doctors that have the same price list. One is better at doctoring and sees more patients. Because there is only the other doctor, their faster appointments represent a higher income than the other doctor. The second doctor still manages to provide competent care to all the patients they see, but they are capturing less economic benefit than Dr. Speedy. Is Dr. Speedy evil for charging the going rate?
"This graph depicting
revenue reveals that
the maternity ward is
quite the cost center. It
should be going up and
to the right!
Smithers, why are there
so few pregnancies? We
need more in-patients,
otherwise our overhead
starts eating away at
our profits."
"Well, sir, I suppose
there aren't as many
teen pregnancies as
there used to be, and
with the benefit of
modern procedures, the
pregnancies we do see
are fairly uncomplicated..."
"Uncomplicated?! Why,
everyone knows live
vaginal births are the
devil's causeway. Those
infants can't be as
healthy as these so-
called 'doctors' seem
to believe. See to it
that more tests are
performed. I'm sure we
can find something wrong
with some of these
freeloaders."
"Hi, everybody!"If a victim won't testify, unless there is alt of other evidence, good luck getting a conviction.