8 ms·

Feds probing psychiatric hospitals for locking in patients to boost profits

74 points by Deinos 9y ago

Overtonwindow 9y ago
You mean like private prisons that trump up charges to extend inmate sentences for profit???
mabbo 9y ago
A great example of how for-profit healthcare (or anything else) can fail. Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits. They do not have a prerogative to benefit society, or help human beings apart from what they choose to do. Every country has to decide whether the benefits of privatisation of the various services outweighs the societal costs caused by private entities having different goals.
- microcolonel 9y ago
  This is a problem localized to psychiatric care, general healthcare has obligations and quality controls, and it doesn't fail in the ways you describe. The fact that medical practitioners take out enormous malpractice insurance policies proves that there is accountability, at least if you're considered sane enough to press charges. For psychiatric care specifically, the problem is that the patient has no agency by definition. The patient can not complain about the hospital, because people think he's too crazy to take care of himself.
  - phren0logy 9y ago
    Nearly everything you have written is incorrect. It's rare to find a psychiatric hospital, public or private, that's not accredited by JCHO. This group has the same standards for general and psychiatric hospitals about patient rights, and due process for any hands-on or involuntary interventions. Psychiatric patients can, and do, complain. The assumption is that they are making a genuine report until proven otherwise.
- wu-ikkyu 9y ago
  Public psychiatric institutions suffer from the same problem though, because the salaries of the employees running the institution are dependent upon a consistent occupancy.
  - mabbo 9y ago
    There's a difference though- if their boss finds out that they did this, in the private sector they'd be rewarded, and in the public sector they'd be fired.
    - microcolonel 9y ago
      That's a pretty bold assertion, do you have any basis for it?
      - mabbo 9y ago
        ... this very article? Where they said that management were explicitly telling doctors to keep patients in longer to make more money?
  - lumberjack 9y ago
    Not really. Public sector employees aren't as incentivised to maximise profits for their employer as private sector employees are. This ultimately makes some public services superior because the employees have no reason to pretend you are are walking wallet instead of a human being.
    - mason240 9y ago
      The history of public institutions has shown otherwise.
  - pjc50 9y ago
    Not to anything like the same manner and extent. In almost all public systems the salaries are dependent upon political considerations first and actual demand is a long way down the list - the system tends to be underprovisioned and demand rarely falls unless there is mass exodus from an area.
- mason240 9y ago
  And if you want to see examples of how government run healthcare (or anything else) can fail, just look at the history of atrocities of public psychiatric hospitals.
  - mistermann 9y ago
    Or visit emergency in most any Canadian hospital.
    - mabbo 9y ago
      I live in Toronto. I've been to the ER here. We were seen promptly, given the right care, and paid no bill. The efficiencies gained by not wasting time on unneeded treatments, not having a billing department and not paying million dollar CEO compensations, these outweigh, in my opinion and experience, any gains we might have via privatization.
      - mistermann 9y ago
        4 to 8 hour waits are fairly routine from what I've heard (Western Canada anyways). Not advocating privatization, just pointing out that the Canadian system is far from the utopia that many Canadians tend to suggest (when the topic is socialized medicare in an international forum.....when the topic is discussed within Canada, many people's opinions deteriorate significantly.)
        mabbo 9y ago
        Well, the Western provinces are very Conservative and don't want to properly fund their health care system. It saves them money on taxes, at the cost of their health. It's a choice they make. If you ask me, their governments do this so that they can argue "See? this is broken! We need to privatize!"
        mistermann 9y ago
        Are you pointing this out as a vulnerability of the public model?
- babyrainbow 9y ago
  >Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits... I love how people generally agree upon this, but when it comes to specific topics, they seem to have a blind spot for this. For ex. Vaccines and how people seem to blindly believe what ever the authority tells them... I mean. Look at this thread. https://www.reddit.com/r/worldnews/comments/6c5k10/italy_makes_12_vaccines_mandatory_for_schoolage/ https://www.reddit.com/r/worldnews/comments/6c5k10/italy_mak... I don't really expect the crowd here to be much better...but anyways...
  - mabbo 9y ago
    You're coming to hacker news to argue that vaccines are actually a conspiracy? Best of luck with that.
    - babyrainbow 9y ago
      Actually I am just noting the curious juxtaposition of these two statements and how the same persons/community can accept both of them at the same time.. >Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits... >There is nothing remotely dubious regarding the enormous push for vaccinations, and we should applaud any measures that mandate the same. Some kind of cognitive dissonance, I guess...
      - thatcat 9y ago
        The argument for mandatory vaccines is that herd immunity protects everyone; if you allow a small population of a disease to survive it will mutate and new vaccines will be needed for everyone else. Wouldn't no vaccines be the most profitable for medical companies since many more people would then require constant treatment?
        babyrainbow 9y ago
        Ok. But you are still trusting that the concerned vaccines has been tested well by benevolent agents, and produced with 100% concern for the consumers/kids, right? Or you would not be so accepting of the same. Is that correct? I was asking about this trust. Where does it come from. And how can it exist among people when the same people believe that "Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits..." >Wouldn't no vaccines be the most profitable for medical companies since many more people would then require constant treatment? Well. Think about it. You are a company producing 10 drugs that people get occasionally. Some of them have some kind of outbreak rarely. How will you mange production of these 10 drugs, when you have no idea of what the demand is going to be. Contrast it with vaccines. That have a constantly growing (possibly at a known rate) demand. Also, it seems that companies are sheielded from vaccine related injuries [1]. So what would you prefer? Just a thought. [1] http://product-liability.lawyers.com/drug-medical-device-litigation/are-drug-companies-liable-for-effects-of-vaccines.html http://product-liability.lawyers.com/drug-medical-device-lit... >The VICP was created by the National Childhood Vaccine Injury Act. The Act is designed to shield pharmaceutical companies from lawsuits in exchange for their continued efforts to make the vaccinations we need. So, because injured patients can't sue the drug companies, the VICP was created to pay them money damages.
entropy128 9y ago
This is an appropriate article to comment with the Rosenhan Experiment. From Wikipedia: The study involved the use of healthy associates or "pseudopatients" who briefly feigned auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had no longer experienced any additional hallucinations. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia "in remission" before their release. [1] This article also makes me think Wells Fargo-esque pressure from above is to blame, but won't be heavily punished by the authorities. At least in the WF case two executives had to pay back $75m. [2] [1] https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment [2] https://www.washingtonpost.com/news/business/wp/2017/04/10/wells-fargo-knew-about-sham-accounts-problem-as-far-back-as-2002 https://www.washingtonpost.com/news/business/wp/2017/04/10/w...
- DanBC 9y ago
  Why is something that happened over forty years ago still relevant today? Literally everything about mental health treatment has changed.
- phkahler 9y ago
  That's an interesting experiment, but what was the expected outcome? The deliberately feigned illness to get in and then reverted to completely normal. That's not a class of patient that is ever expected to show up. How would someone expect those cases to be handled and why?
  - Doxin 9y ago
    You'd at the very least expect medical experts to be able to identify non-ill people. That part of the experiment isn't the most damning though, The part where they told hospitals they'd repeat the experiment and then didn't is. Suddenly the hospitals managed to finger many of their patients as pseudopatients when in fact they weren't even part of the experiment. So yeah, a mental health industry that can't differentiate between sane and insane in either direction scares me.
DarkKomunalec 9y ago
Looking forward to charges of fraud and, where applicable, imprisonment under false pretenses[1], resulting in stiff prison sentences for those responsible. [1]: The notion that psychiatric hospitals should be able to keep people there against their will is extremely suspect. A possible exception is a patient being convicted in court of an actual crime, and sent there instead of to prison by the legal system. Even then, the very likely possibility that the hospital staff would extend the patients stay indefinitely would necessitate the judge setting some upper bound on how long the patient can be kept against their will.
- Kenji 9y ago
  Don't kid yourself. Nobody will be punished for this. Well, maybe some little people who were instructed to do the deed.
- Jare 9y ago
  > The notion that psychiatric hospitals should be able to keep people there against their will is extremely suspect It is necessary to some extent because of the impact that mental and psychiatric conditions have on the will itself. But some patient-appointed external agent with formal qualifications and the power to balance decisions, even if imperfect, would go a long ways.
  - DarkKomunalec 9y ago
    Necessary or not, no institution should have the power to imprison without all the safeguards of a criminal trial.
    - outlace 9y ago
      Every state does it differently but in California, you can be held involuntarily for up to 3 days just on the judgement of police or a psychiatrist but being held longer than that does require a hearing with a judge and an attorney where the patient, however impaired or not, can plead their case.
seibelj 9y ago
My grandma was kept alive an extra 10 days to let her medicare run out in rural Oklahoma. I'm not sure of all the details because it was 15 years ago and I was a teenager, but my dad said medicare stopped paying for some level of care and then they let her die (she was a vegetable from a stroke).
wu-ikkyu 9y ago
Private prisons profit from recidivism (rather than rehabilitation) just as psychiatric "hospitals" do. Though at least in a private prison, you know how long your sentence is, it is an objective measure. When imprisoned in a mental asylum, you don't know how long you will be in there for, because your release is dependent on the subjective whim of those who stand to profit from the continued occupancy. There are no objective tests to determine whether or not a person is mentally ill, and this further exacerbates the existing conflict of interest.
- microcolonel 9y ago
  This is why there needs to be third-party monitoring, with enormous penalties for misconduct. Public or private, there is no way to make sure this isn't happening unless a hostile party is watching everything.
jstanley 9y ago
This is one of my greatest fears: that I'll be labelled as insane, then taken away and locked up against my will, and when I try to plead sanity, nobody will believe me. Because they "know" I'm insane.
- zero_intp 9y ago
  A favorite movie of mine on this subject is Lunacy. https://en.wikipedia.org/wiki/Lunacy_(film) https://en.wikipedia.org/wiki/Lunacy_(film)
- DanBC 9y ago
  Make an advanced directive, and speak to your nearest relative. I'm not sure of the law in the US, but I think you have to pose an active danger to yourself or other people for them to detain you, and they can only hold you for short times. Abuses do happen (which is why you need to talk to your nearest relative and get and advance directive in place) but they're rare. https://en.wikipedia.org/wiki/Involuntary_commitment_internationally#United_States https://en.wikipedia.org/wiki/Involuntary_commitment_interna...
  - psyc 9y ago
    Unfortunately, justice is glacial, and the law doesn't protect you in the short term. The devil is in the implementation, and the actors. You don't have to be a danger to yourself or others. Only one psychiatrist in the ER has to say that they estimate you are. I'm not aware they have any incentive not to hold you, and increase their liability. Next, you'll hear they can hold you for 72 hours to evaluate you. That's meaningless. They can hold you for as long as they want to. At the end of 72 hours they can decide to commit you, or even easier, they can bully you into admitting yourself voluntarily, implying they'll commit you otherwise. If you stay "voluntarily" and then try to sign out at a later date, they can again bully you by threatening to take you to court. If they commit you, you get a court hearing a few weeks later. The rules of the hearing couldn't be simpler: the judge does exactly what the psychiatrist recommends, full stop. After that, appeals become increasingly fewer and further between. If you're being held 'wrongly' (i.e. you disagree with their assessment) you're entirely on your own to find competent advocates. It can be very difficult, and it can take months before you find someone who wants to make anything happen. Last time I was in, it took me 2 months of working the phone every day, until I somehow managed to reach a high-up lawyer with the state board of oversight. And they just happened to be a nice person who sympathized with my situation. As I said upthread, you really do not want to get committed if you have state insurance. Private insurance will try to shorten your stay. State insurance leaves you at the hands of the institution. Until I found that lawyer (who had me out after another 2 weeks) the doctors were working on transferring me to a long-term state hospital.
phren0logy 9y ago
I'm a psychiatrist, and there are a few things to consider about this story: 1. The bulk of people in a psychiatric hospital are there voluntarily. They can walk out the door at any time. 2. When a patient is in a hospital involuntarily, their stay is subject to state laws about involuntary hospitalization. This, as far as I know, universally requires 2 independent professional opinions that a patient is actively suicidal, actively homicidal, or overtly incapable of taking care of themselves to the point it puts their health at risk. 3. Psychiatric stays are generally very short (less than 5 days), despite the fact that most medications don't start working that quickly. Stays have become unrealistically short. 4. Despite the general outcry about involuntary hospitalization, most family members of a person with a severe illness will tell you that they struggle to get their loved ones admitted even when the situation gets dire. 5. Again despite the outcry, a number of states have been expanding the liability of psychiatrists for the actions of their patients. For example, if my patient were to hurt themselves or someone else, I can expect years of depositions and lawsuits. This does not justify hospitalizing someone who does not need it, but does speak to a double standard about our role in protecting society. THIS LIABILITY STILL APPLIES WHEN AN INSURANCE COMPANY TELLS ME THEY ARE GOING TO STOP PAYING FOR HOSPITAL TIME 2 DAYS AFTER SOMEONE TRIED TO HANG THEMSELVES. If I release them, it's on me. If I keep them, they face huge bills even if they have insurance. This sucks. 6. MOST IMPORTANTLY, WITHOUT INVOLUNTARY COMMITMENT MANY PATIENTS GO TO JAIL OR PRISON. I work in correctional settings. The decline in psychiatric beds is strongly correlated with the spike in mentally ill people behind bars. Without an avenue to get them treated, they end up getting arrested for their behavior, when they should have gotten treatment instead.
- psyc 9y ago
  Correction: psychiatric stays are generally very short with private insurance, and months long with state insurance. May vary with the level of corruption in your area.
  - phren0logy 9y ago
    I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.
zero_intp 9y ago
Two items, this is nothing new, although it is good to see it getting news and federal attention. 20 years ago, as a minor, I was subjected to delayed releases as well as odd provocations from the care workers. In the end it took a parent rebelling and pulling me out against medical advice. Secondly, go fuck yourself, don't try to cover up involuntary restraint and criminal behavior.
- phren0logy 9y ago
  I'm not trying to cover up anything. Abuses happen, and they should not be tolerated.
  - hashkb 9y ago
    Your comment implies the situation is less bad than the article suggests. To someone held under shady practices, you look like one of 'them'. I wouldn't outright deny that person's point of view. Are you sure you are a psychologist?
    - maxerickson 9y ago
      They've directly stated that they are a psychiatrist rather than a psychologist. If you are going to be all edgy, please read carefully and be accurate and precise.
      - hashkb 9y ago
        See my reply to the other comment that said what you said.
    - DanBC 9y ago
      > Are you sure you are a psychologist? Do you know the difference between a psychiatrist and a psychologist? Many people don't, but in the context of this conversation it's pretty important.
      - 9y ago
eth0up 9y ago
I once met a mural artist who told me a very memorable story of his peculiar time at the cuckoo's nest, how he got there and how he left. It was the 1960s-70s and all had been reasonably normal in his life, until his attendance at a certain party. Though he was untroubled in the company of recreational drug fiends, he didn't participate, at least not deliberately. However, someone had surreptitiously spiked the punchbowl with LSD. Being a gentle and kind sort of creature, he unwittingly embarked on a profound psychedelic odyssey. Still under the effects of the punch and yet unable to rationalize the situation, he called his sister for help, who persuaded him against his better judgment to check in to a psychiatric hospital. Shortly after, his state of mind returned to normal where he was able to assess the cause, but the talons of the ward took hold and would not let him go. They'd already begun to medicate him heavily with tranquilizers which clouded his mind and dulled his resolve. His pleas for understanding were ignored and he soon realized that he'd become a prisoner. In this situation his only assets were his art and good character. In a sanctioned stupor he devised a plan; he would begin "cheeking" his medicine in the presence of the nurses and spitting it out in their absence. He was permitted art supplies, the results of which quickly earned him respect among the staff. He'd use this to eventually obtain permission to paint outside in the courtyard, where he'd scan every possible vector for a way out. His fear had began to impel him after seeing inmates which were previously articulate and sociable become zombies after what he presumed were lobotomies. He suspected he was on the list for the same. Once he gained the trust of the staff, he finally sprang for freedom. He got it and never returned. He carried on with his art, remaining perfectly sane, innocuous and successful in his trade.

74 points by Deinos 9y ago

You mean like private prisons that trump up charges to extend inmate sentences for profit???

A great example of how for-profit healthcare (or anything else) can fail. Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits. They do not have a prerogative to benefit society, or help human beings apart from what they choose to do. Every country has to decide whether the benefits of privatisation of the various services outweighs the societal costs caused by private entities having different goals.

microcolonel 9y ago
This is a problem localized to psychiatric care, general healthcare has obligations and quality controls, and it doesn't fail in the ways you describe. The fact that medical practitioners take out enormous malpractice insurance policies proves that there is accountability, at least if you're considered sane enough to press charges. For psychiatric care specifically, the problem is that the patient has no agency by definition. The patient can not complain about the hospital, because people think he's too crazy to take care of himself.
- phren0logy 9y ago
  Nearly everything you have written is incorrect. It's rare to find a psychiatric hospital, public or private, that's not accredited by JCHO. This group has the same standards for general and psychiatric hospitals about patient rights, and due process for any hands-on or involuntary interventions. Psychiatric patients can, and do, complain. The assumption is that they are making a genuine report until proven otherwise.
wu-ikkyu 9y ago
Public psychiatric institutions suffer from the same problem though, because the salaries of the employees running the institution are dependent upon a consistent occupancy.
- mabbo 9y ago
  There's a difference though- if their boss finds out that they did this, in the private sector they'd be rewarded, and in the public sector they'd be fired.
  - microcolonel 9y ago
    That's a pretty bold assertion, do you have any basis for it?
    - mabbo 9y ago
      ... this very article? Where they said that management were explicitly telling doctors to keep patients in longer to make more money?
- lumberjack 9y ago
  Not really. Public sector employees aren't as incentivised to maximise profits for their employer as private sector employees are. This ultimately makes some public services superior because the employees have no reason to pretend you are are walking wallet instead of a human being.
  - mason240 9y ago
    The history of public institutions has shown otherwise.
- pjc50 9y ago
  Not to anything like the same manner and extent. In almost all public systems the salaries are dependent upon political considerations first and actual demand is a long way down the list - the system tends to be underprovisioned and demand rarely falls unless there is mass exodus from an area.
mason240 9y ago
And if you want to see examples of how government run healthcare (or anything else) can fail, just look at the history of atrocities of public psychiatric hospitals.
- mistermann 9y ago
  Or visit emergency in most any Canadian hospital.
  - mabbo 9y ago
    I live in Toronto. I've been to the ER here. We were seen promptly, given the right care, and paid no bill. The efficiencies gained by not wasting time on unneeded treatments, not having a billing department and not paying million dollar CEO compensations, these outweigh, in my opinion and experience, any gains we might have via privatization.
    - mistermann 9y ago
      4 to 8 hour waits are fairly routine from what I've heard (Western Canada anyways). Not advocating privatization, just pointing out that the Canadian system is far from the utopia that many Canadians tend to suggest (when the topic is socialized medicare in an international forum.....when the topic is discussed within Canada, many people's opinions deteriorate significantly.)
      - mabbo 9y ago
        Well, the Western provinces are very Conservative and don't want to properly fund their health care system. It saves them money on taxes, at the cost of their health. It's a choice they make. If you ask me, their governments do this so that they can argue "See? this is broken! We need to privatize!"
        mistermann 9y ago
        Are you pointing this out as a vulnerability of the public model?
babyrainbow 9y ago
>Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits... I love how people generally agree upon this, but when it comes to specific topics, they seem to have a blind spot for this. For ex. Vaccines and how people seem to blindly believe what ever the authority tells them... I mean. Look at this thread. https://www.reddit.com/r/worldnews/comments/6c5k10/italy_makes_12_vaccines_mandatory_for_schoolage/ https://www.reddit.com/r/worldnews/comments/6c5k10/italy_mak... I don't really expect the crowd here to be much better...but anyways...
- mabbo 9y ago
  You're coming to hacker news to argue that vaccines are actually a conspiracy? Best of luck with that.
  - babyrainbow 9y ago
    Actually I am just noting the curious juxtaposition of these two statements and how the same persons/community can accept both of them at the same time.. >Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits... >There is nothing remotely dubious regarding the enormous push for vaccinations, and we should applaud any measures that mandate the same. Some kind of cognitive dissonance, I guess...
    - thatcat 9y ago
      The argument for mandatory vaccines is that herd immunity protects everyone; if you allow a small population of a disease to survive it will mutate and new vaccines will be needed for everyone else. Wouldn't no vaccines be the most profitable for medical companies since many more people would then require constant treatment?
      - babyrainbow 9y ago
        Ok. But you are still trusting that the concerned vaccines has been tested well by benevolent agents, and produced with 100% concern for the consumers/kids, right? Or you would not be so accepting of the same. Is that correct? I was asking about this trust. Where does it come from. And how can it exist among people when the same people believe that "Corporate entities have an obligation to do whatever they can legally get away with in order to maximize profits..." >Wouldn't no vaccines be the most profitable for medical companies since many more people would then require constant treatment? Well. Think about it. You are a company producing 10 drugs that people get occasionally. Some of them have some kind of outbreak rarely. How will you mange production of these 10 drugs, when you have no idea of what the demand is going to be. Contrast it with vaccines. That have a constantly growing (possibly at a known rate) demand. Also, it seems that companies are sheielded from vaccine related injuries [1]. So what would you prefer? Just a thought. [1] http://product-liability.lawyers.com/drug-medical-device-litigation/are-drug-companies-liable-for-effects-of-vaccines.html http://product-liability.lawyers.com/drug-medical-device-lit... >The VICP was created by the National Childhood Vaccine Injury Act. The Act is designed to shield pharmaceutical companies from lawsuits in exchange for their continued efforts to make the vaccinations we need. So, because injured patients can't sue the drug companies, the VICP was created to pay them money damages.

entropy128 9y ago

This is an appropriate article to comment with the Rosenhan Experiment. From Wikipedia: The study involved the use of healthy associates or "pseudopatients" who briefly feigned auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had no longer experienced any additional hallucinations. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. All but one were diagnosed with schizophrenia "in remission" before their release. [1] This article also makes me think Wells Fargo-esque pressure from above is to blame, but won't be heavily punished by the authorities. At least in the WF case two executives had to pay back $75m. [2] [1] https://en.wikipedia.org/wiki/Rosenhan_experiment https://en.wikipedia.org/wiki/Rosenhan_experiment [2] https://www.washingtonpost.com/news/business/wp/2017/04/10/wells-fargo-knew-about-sham-accounts-problem-as-far-back-as-2002 https://www.washingtonpost.com/news/business/wp/2017/04/10/w...

DanBC 9y ago
Why is something that happened over forty years ago still relevant today? Literally everything about mental health treatment has changed.
phkahler 9y ago
That's an interesting experiment, but what was the expected outcome? The deliberately feigned illness to get in and then reverted to completely normal. That's not a class of patient that is ever expected to show up. How would someone expect those cases to be handled and why?
- Doxin 9y ago
  You'd at the very least expect medical experts to be able to identify non-ill people. That part of the experiment isn't the most damning though, The part where they told hospitals they'd repeat the experiment and then didn't is. Suddenly the hospitals managed to finger many of their patients as pseudopatients when in fact they weren't even part of the experiment. So yeah, a mental health industry that can't differentiate between sane and insane in either direction scares me.

DarkKomunalec 9y ago

Looking forward to charges of fraud and, where applicable, imprisonment under false pretenses[1], resulting in stiff prison sentences for those responsible. [1]: The notion that psychiatric hospitals should be able to keep people there against their will is extremely suspect. A possible exception is a patient being convicted in court of an actual crime, and sent there instead of to prison by the legal system. Even then, the very likely possibility that the hospital staff would extend the patients stay indefinitely would necessitate the judge setting some upper bound on how long the patient can be kept against their will.

Kenji 9y ago
Don't kid yourself. Nobody will be punished for this. Well, maybe some little people who were instructed to do the deed.
Jare 9y ago
> The notion that psychiatric hospitals should be able to keep people there against their will is extremely suspect It is necessary to some extent because of the impact that mental and psychiatric conditions have on the will itself. But some patient-appointed external agent with formal qualifications and the power to balance decisions, even if imperfect, would go a long ways.
- DarkKomunalec 9y ago
  Necessary or not, no institution should have the power to imprison without all the safeguards of a criminal trial.
  - outlace 9y ago
    Every state does it differently but in California, you can be held involuntarily for up to 3 days just on the judgement of police or a psychiatrist but being held longer than that does require a hearing with a judge and an attorney where the patient, however impaired or not, can plead their case.

seibelj 9y ago

My grandma was kept alive an extra 10 days to let her medicare run out in rural Oklahoma. I'm not sure of all the details because it was 15 years ago and I was a teenager, but my dad said medicare stopped paying for some level of care and then they let her die (she was a vegetable from a stroke).

wu-ikkyu 9y ago

Private prisons profit from recidivism (rather than rehabilitation) just as psychiatric "hospitals" do. Though at least in a private prison, you know how long your sentence is, it is an objective measure. When imprisoned in a mental asylum, you don't know how long you will be in there for, because your release is dependent on the subjective whim of those who stand to profit from the continued occupancy. There are no objective tests to determine whether or not a person is mentally ill, and this further exacerbates the existing conflict of interest.

microcolonel 9y ago
This is why there needs to be third-party monitoring, with enormous penalties for misconduct. Public or private, there is no way to make sure this isn't happening unless a hostile party is watching everything.

jstanley 9y ago

This is one of my greatest fears: that I'll be labelled as insane, then taken away and locked up against my will, and when I try to plead sanity, nobody will believe me. Because they "know" I'm insane.

zero_intp 9y ago
A favorite movie of mine on this subject is Lunacy. https://en.wikipedia.org/wiki/Lunacy_(film) https://en.wikipedia.org/wiki/Lunacy_(film)
DanBC 9y ago
Make an advanced directive, and speak to your nearest relative. I'm not sure of the law in the US, but I think you have to pose an active danger to yourself or other people for them to detain you, and they can only hold you for short times. Abuses do happen (which is why you need to talk to your nearest relative and get and advance directive in place) but they're rare. https://en.wikipedia.org/wiki/Involuntary_commitment_internationally#United_States https://en.wikipedia.org/wiki/Involuntary_commitment_interna...
- psyc 9y ago
  Unfortunately, justice is glacial, and the law doesn't protect you in the short term. The devil is in the implementation, and the actors. You don't have to be a danger to yourself or others. Only one psychiatrist in the ER has to say that they estimate you are. I'm not aware they have any incentive not to hold you, and increase their liability. Next, you'll hear they can hold you for 72 hours to evaluate you. That's meaningless. They can hold you for as long as they want to. At the end of 72 hours they can decide to commit you, or even easier, they can bully you into admitting yourself voluntarily, implying they'll commit you otherwise. If you stay "voluntarily" and then try to sign out at a later date, they can again bully you by threatening to take you to court. If they commit you, you get a court hearing a few weeks later. The rules of the hearing couldn't be simpler: the judge does exactly what the psychiatrist recommends, full stop. After that, appeals become increasingly fewer and further between. If you're being held 'wrongly' (i.e. you disagree with their assessment) you're entirely on your own to find competent advocates. It can be very difficult, and it can take months before you find someone who wants to make anything happen. Last time I was in, it took me 2 months of working the phone every day, until I somehow managed to reach a high-up lawyer with the state board of oversight. And they just happened to be a nice person who sympathized with my situation. As I said upthread, you really do not want to get committed if you have state insurance. Private insurance will try to shorten your stay. State insurance leaves you at the hands of the institution. Until I found that lawyer (who had me out after another 2 weeks) the doctors were working on transferring me to a long-term state hospital.

phren0logy 9y ago

I'm a psychiatrist, and there are a few things to consider about this story: 1. The bulk of people in a psychiatric hospital are there voluntarily. They can walk out the door at any time. 2. When a patient is in a hospital involuntarily, their stay is subject to state laws about involuntary hospitalization. This, as far as I know, universally requires 2 independent professional opinions that a patient is actively suicidal, actively homicidal, or overtly incapable of taking care of themselves to the point it puts their health at risk. 3. Psychiatric stays are generally very short (less than 5 days), despite the fact that most medications don't start working that quickly. Stays have become unrealistically short. 4. Despite the general outcry about involuntary hospitalization, most family members of a person with a severe illness will tell you that they struggle to get their loved ones admitted even when the situation gets dire. 5. Again despite the outcry, a number of states have been expanding the liability of psychiatrists for the actions of their patients. For example, if my patient were to hurt themselves or someone else, I can expect years of depositions and lawsuits. This does not justify hospitalizing someone who does not need it, but does speak to a double standard about our role in protecting society. THIS LIABILITY STILL APPLIES WHEN AN INSURANCE COMPANY TELLS ME THEY ARE GOING TO STOP PAYING FOR HOSPITAL TIME 2 DAYS AFTER SOMEONE TRIED TO HANG THEMSELVES. If I release them, it's on me. If I keep them, they face huge bills even if they have insurance. This sucks. 6. MOST IMPORTANTLY, WITHOUT INVOLUNTARY COMMITMENT MANY PATIENTS GO TO JAIL OR PRISON. I work in correctional settings. The decline in psychiatric beds is strongly correlated with the spike in mentally ill people behind bars. Without an avenue to get them treated, they end up getting arrested for their behavior, when they should have gotten treatment instead.

psyc 9y ago
Correction: psychiatric stays are generally very short with private insurance, and months long with state insurance. May vary with the level of corruption in your area.
- phren0logy 9y ago
  I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.

zero_intp 9y ago

Two items, this is nothing new, although it is good to see it getting news and federal attention. 20 years ago, as a minor, I was subjected to delayed releases as well as odd provocations from the care workers. In the end it took a parent rebelling and pulling me out against medical advice. Secondly, go fuck yourself, don't try to cover up involuntary restraint and criminal behavior.

phren0logy 9y ago
I'm not trying to cover up anything. Abuses happen, and they should not be tolerated.
- hashkb 9y ago
  Your comment implies the situation is less bad than the article suggests. To someone held under shady practices, you look like one of 'them'. I wouldn't outright deny that person's point of view. Are you sure you are a psychologist?
  - maxerickson 9y ago
    They've directly stated that they are a psychiatrist rather than a psychologist. If you are going to be all edgy, please read carefully and be accurate and precise.
    - hashkb 9y ago
      See my reply to the other comment that said what you said.
  - DanBC 9y ago
    > Are you sure you are a psychologist? Do you know the difference between a psychiatrist and a psychologist? Many people don't, but in the context of this conversation it's pretty important.
    - 9y ago

eth0up 9y ago

I once met a mural artist who told me a very memorable story of his peculiar time at the cuckoo's nest, how he got there and how he left. It was the 1960s-70s and all had been reasonably normal in his life, until his attendance at a certain party. Though he was untroubled in the company of recreational drug fiends, he didn't participate, at least not deliberately. However, someone had surreptitiously spiked the punchbowl with LSD. Being a gentle and kind sort of creature, he unwittingly embarked on a profound psychedelic odyssey. Still under the effects of the punch and yet unable to rationalize the situation, he called his sister for help, who persuaded him against his better judgment to check in to a psychiatric hospital. Shortly after, his state of mind returned to normal where he was able to assess the cause, but the talons of the ward took hold and would not let him go. They'd already begun to medicate him heavily with tranquilizers which clouded his mind and dulled his resolve. His pleas for understanding were ignored and he soon realized that he'd become a prisoner. In this situation his only assets were his art and good character. In a sanctioned stupor he devised a plan; he would begin "cheeking" his medicine in the presence of the nurses and spitting it out in their absence. He was permitted art supplies, the results of which quickly earned him respect among the staff. He'd use this to eventually obtain permission to paint outside in the courtyard, where he'd scan every possible vector for a way out. His fear had began to impel him after seeing inmates which were previously articulate and sociable become zombies after what he presumed were lobotomies. He suspected he was on the list for the same. Once he gained the trust of the staff, he finally sprang for freedom. He got it and never returned. He carried on with his art, remaining perfectly sane, innocuous and successful in his trade.