UNJUSTIFIED PSYCHIATRIC
COMMITMENT in the U.S.A.
by Lawrence Stevens, J.D.
In 1992, U.S. Representative Patricia Schroeder of Colorado held
hearings investigating the practices of psychiatric hospitals in
the United States. Rep. Schroeder summarized her committee's
findings as follows: "Our investigation has found that
thousands of adolescents, children, and adults have been
hospitalized for psychiatric treatment they didn't need; that
hospitals hire bounty hunters to kidnap patients with mental
health insurance; that patients are kept against their will until
their insurance benefits run out; that psychiatrists are being
pressured by the hospitals to increase profit; that hospitals
'infiltrate' schools by paying kickbacks to school counselors
who deliver students; that bonuses are paid to hospital
employees, including psychiatrists, for keeping the hospital
beds filled; and that military dependents are being targeted for
their generous mental health benefits. I could go on, but
you get the picture" (quoted in: Lynn Payer, Disease-
Mongers: How Doctors, Drug Companies, and Insurers Are Making You
Feel Sick, John Wiley & Sons, Inc., 1992, pp.
234-235).
A headline on the
front page of the July 6, 1986 Oakland, California Tribune
reads: "Adolescents are packing private mental hospitals
But do most of them belong there?" The newspaper
article says: "...mental patients advocates say many
adolescents in private hospitals are not seriously mentally ill,
but merely rebellious. By holding the adolescents, who
often dislike hospitalization, advocates say private hospitals
reap profits and please parents. ... Some county mental
health officials and psychiatrists at private hospitals
acknowledge there are hospitalized adolescents who, ideally,
shouldn't be there. ... 'It distresses me to see kids in these
facilities; it distressesme to see the profits going on,' Jay
Mahler, of Patients Rights Advocacy and Training, said two weeks
ago at a Concord Public forum. 'It's a hot business,' Tim
Goolsby, a Contra Costa County Probation Department adolescent
placement supervisor, later agreed. 'If your kids like sex,
drugs, and rock'n'roll, that's the place to put them. I'm
not sure insurance companies know what's going on, but they're
being ripped off.' Goolsby estimated 80 percent of
adolescents in Contra Costa private psychiatric hospitals are not
mentally ill... University of Southern California sociologists
Patricia Guttridge and Carol Warren say these adolescents have
been transformed from delinquents to emotionally disturbed
children. After studying 1,119 adolescents in four Los
Angeles-area psychiatric hospitals, they found that less than a
fifth were admitted for serious mental illnesses" (Susan
Stern, The Tribune (Oakland, California), Sunday, July 6,
1986, p. A-1 & A-2).
In the February 1988
Stanford Law Journal Lois A. Weithorn, Ph.D., a former
University of Virginia psychology professor, said
"adolescent admission rates to psychiatric units of private
hospitals have jumped dramatically, increasing over four-fold
between 1980 and 1984. ... I contend that the rising rates of
psychiatric admission of children and adolescents reflect an
increasing use of hospitalization to manage a population for whom
such intervention is typically inappropriate: 'troublesome' youth
who do not suffer from severe mental disorders" (40 Stanford
Law Review 773 at 773-774).
Psychiatric and
psychological "diagnosis" is arbitrary and unreliable.
Furthermore, the supposed experts responsible for these
"diagnoses" are usually biased in favor of commitment
because of their personal economic concerns or their affiliation
with the psychiatric "hospital" where the
"patient" is or will be confined. Psychiatric
"hospitals", like all businesses, need customers.
In the case of psychiatric "hospitals", they
need patients. They not only want patients, they
need them to stay in business. Similarly, individual
psychiatrists and psychologists need patients to make money and
earn a living. A magazine article published in 1992
criticizing the trend towards locking up troublesome teenagers
alleged that teenagers are locked up in psychiatric hospitals
today more than in the past because "busy parents are less
willing to deal with their behavior and because inpatient
psychiatric business represents a profitable market in the
health-care field." The result has been an increase
in the number of psychiatric hospitals in recent years,
"from 220 in 1984 to 341 in 1988". This increase
in the number of psychiatric hospitals has resulted in keen
competition between hospitals and psychiatrists for patients.
"Keeping all those psychiatric beds filled is critical, and
administrators are aggressively ensuring that they will be.
Hard-sell TV, radio, and magazine ads (up to tenfold in the
past few years, according to Metz) are ubiquitous ... Some
facilities even resort to paying employees and others bonuses of
$500 to $1,000 per referral. ... Rebellious teenagers used
to be grounded. New they're being committed.
Increasingly, parents are locking up their unruly kids in
the psychiatric wards of private hospitals for engaging in what
many therapists call normal adolescent behavior. Adolescent
psychiatric admissions have gone up 250 or 400 percent since
1980, reports Holly Metz in The Progressive (Dec. 1991), but
it's not because teens are suddenly so much crazier than they
were a decade ago. Indeed, the Children's Defense Fund
suggests that at least 40 percent of these juvenile admissions
are inappropriate, while a Family Therapy Networker (July/Aug.
1990) youth expert puts that figure at 75 percent" (Lynette
Lamb, "Kids in the Cuckoo's Nest Why are we locking
up America's troublesome teens?", Utne Reader,
March/April pp. 38, 40).
In her book And
They Call It Help - The Psychiatric Policing of America's
Children, published in 1993, Louise Armstrong laments
"the 65 percent of kids in private, for-profit psych
hospitals who simply do not need to be there but are given
severe-sounding labels nonetheless" (Addison-Wesley Pub.
Co., p. 167 - italics in original).
Unjustified
involuntary commitment to psychiatric hospitals has become so
blatant Reader's Digest published an article in the July
1992 issue exposing the unethical practice:
"Similar storm
clouds are appearing over the mental - health field.
Alarmed by exploding costs, insurance companies began
scrutinizing payments more carefully - and ultimately trimmed
the average patient's length of hospital stay. As a result,
'private hospitals that once made a great deal of money are now
desperate for patients,' says Dr. Alan Stone, former president of
the American Psychiatric Association.
"That desperation
has opened the door for fraud. Among the alleged abuses:
patients abducted by 'bounty hunters'; others hospitalized
against their will until their insurance runs out; diagnoses and
treatments tailored to maximize insurance reimbursement;
kickbacks for recruiting patients; unnecessary treatments; gross
overbilling.
"The most
infamous charges were leveled in Texas. On April 4, 1991, two
private security agents showed up at the Harrell family home in
Live Oak to pick up Jeramy Harrell, 14, and admit him on
suspicion of drug abuse to Colonial Hills Hospital, a private
psychiatric facility in San Antonio.
"Family members
believed the agents to be law-enforcement officers. If
Jeramy didn't cooperate, the agents said, they could obtain a
warrant and have him detained for 28 days. 'They acted
just like the Gestapo,' the boy's grandmother - and legal
guardian - later told a Texas state senate committee.
"According to
that testimony, Jeramy was denied any contact with his family for
six days and released only after a state senator [Frank Tejeda,
now in Congress] intervened. State officials discovered
the boy had been ordered detained by a staff doctor after his
disturbed younger brother lied about Jeramy's supposed drug use.
The guards who brought him in worked for a private firm
paid by Colonial Hills for each patient delivered. ...
"Soon after the
ordeal, the Harrells got a bill for Jeramy's six-day stay, a
stunning $11,000. The hospital's owner denied any
wrongdoing.
"The Harrell case
led to those Texas senate hearings, which in turn brought to
light other allegations of fraud and abuse involving some 12
other Texas facilities and at least three other national
hospital chains. Similar charges have been made against
hospitals in New Jersey, Florida, Alabama and Louisiana; three
federal agencies have opened investigations, and more than a
dozen states have probes under way" (Gordon Witkin,
"Beware These Health Scams", Reader's Digest,
July 1992, p. 142 at 144-146).
In 1991 or 1992 an
administrator at a psychiatric "hospital" told me
competition between psychiatric hospitals is what she called
"cut throat". Combine this intense competition
with America's poorly written involuntary commitment laws and
judges who refuse to impose protection from unwarranted
commitment that bona-fide due process requires, and the result
is a lot of people being deprived of liberty and suffering
psychiatric stigma unjustifiably. In the field of
so-called mental health where large amounts of money can be
made, in large part because of health insurance, and where there
is a competitive environment where there are too few psychiatric
"patients" to fill psychiatric beds, self-interest
biases the supposed psychiatric or psychological experts in
favor of a "diagnosis" which justifies commitment,
including involuntary commitment where necessary. As
Harvard Law professor Alan M. Dershowitz has said, psychiatry
"is not a scientific discipline" ("Clash of
Testimony in Hinkley Trial Has Psychiatrists Worried Over
Image", The New York Times May 24, 1982, p. 11).
The opinion of many legislators and judges that
impartiality, objectivity, and scientific expertise of mental
health professionals makes the kind of due process needed
elsewhere unnecessary in psychiatric commitment is mistaken.
As was noted in the
above quoted Reader's Digest article, much of this
unjustified involuntary psychiatric commitment of normal and
law-abiding people to the prisons called psychiatric hospitals is
motivated by the financial needs of psychiatric hospitals and
the people who work in them. Although it has been reaching
newspaper headlines in only the last several years, unwarranted
psychiatric commitment has been going on for over a century,
including in the USA where freedom is supposedly a cherished
value and where human rights are supposedly respected. Recent
inventions such as health care insurance have made the abuses
more frequent, but the willingness of mental health
"professionals" to violate the sacred right of each
law-abiding person to liberty isn't new.
What is most needed is
recognition that there is no such thing as "mental
illness". That alone undermines the justification for
most involuntarily imposed so-called psychiatric care.
Rather than being a bona-fide illness, the mental
"illness" label is value judgment about a
person's behavior. But as long as incarceration for
so-called mental illness continues, those accused of it should
be given the same rights as defendants in criminal cases.
America's established history of unwarranted psychiatric
commitment shows this protection is necessary. These
rights include trial by jury, a procedure for assuring the
defendant or so-called proposed patient has been advised of when
and how to invoke his or her right to jury trial, an absolute
prohibition of incommunicado confinement (particularly during
the pre-trial period), the right to confront and cross-examine
opposing witnesses, the right to call one's own witnesses,
conviction or commitment only if there is proof beyond a
reasonable doubt, freedom from double-jeopardy, and assistance of
legal counsel. The prohibition of incommunicado confinement
must be absolute, because if psychiatrists are permitted by law
to hold prisoners ("patients") incommunicado in
"emergencies", that power will often be used routinely
(without emergency). Another safeguard prisoners of
psychiatry need is protection from being mentally disabled by
forcibly administered psychiatric drugs or electric shock
treatment prior to their day in court. Of all these
due-process rights, the right to jury trial and the right to not
be mentally disabled by psychiatric drugs or electric shock
treatment prior to one's day in court are unquestionably the
most important. Many states have provided a right to jury trial
in psychiatric commitment cases by statute, but many have not;
and judges often refuse to grant it as a constitutional
right. Judges are as capable as psychiatrists of deciding
what to
do with people accused of mental illness, but few will even
attempt to do so and will instead approve a psychiatrist's
request for commitment without even the slightest attempt at
real judicial review. The importance of the right to jury
trial is illustrated by the remark of a court clerk who told me,
in the judge's presence, that the judge felt if he didn't follow
the doctor's recommendation regarding commitment, "the
Court would be practicing medicine without a license."
This illogical statement, which the judge seemed to agree
with (indicated by his silence as he listened to his clerk say
this and by his conduct in court) reveals the extent to which
judges have abdicated their responsibility in this area to
psychiatrists. The invalidity and unreliability of
psychiatric "diagnosis", often complicated by the
psychiatrist's financial stake in getting the so-called patient
committed, combined with the immutable reluctance of most judges
to use their own independent judgment, makes a jury absolutely
essential for a fair trial in psychiatric commitment cases.
This is truly a case of "NO JURY - NO
JUSTICE".
Far from anything
idealistic like law or concern for human rights, the primary
forces curtailing unnecessary involuntary psychiatric
"hospitalization" in the USA have been insurance
companies motivated not by idealism but by monetary concerns.
As Tim Goolsby remarked in 1986 (above), "they [the
health insurance companies] [a]re being ripped off."
Eventually the health insurance companies became aware of
the needless psychiatric treatment they were paying for.
According to a front-page article in the August 3, 1992
issue of Investor's Business Daily: "Last
Thursday...eight major insurance companies sued NME [National
Medical Enterprises] for alleged fraud involving hundreds of
millions of dollars in psychiatric hospital claims. Their
complaint, filed in federal court in Washington, accused the
company of a 'massive' scheme to admit and treat thousands of
patients regardless of their need for care. ...some
institutions were paying 'bounty fees' for patient referrals or
misdiagnosing patients to get maximum reimbursement"
(Christine Shenot, "Bleeder at National Medical Insurers
Cry Of 'Fraud' Reopened A Big Wound", Investor's Business
Daily, Monday, August 3, 1992, p. 1). Time
magazine later reported NME settled the case for a record $300
million (April 25, 1994, p. 24). An article about a similar suit
filed in Dallas, Texas appeared in the September 15, 1992 issue
of New York Newsday, saying: "Two of the country's
largest insurance companies filed suit yesterday against a
national chain of private psychiatric and substance abuse
hospitals, charging it with illegally admitting patients who did
not need treatment and then not releasing them until their
insurance benefits ran out" Michael Unger, "Hospitals
Called Cheats Insurers say health-care chain pulled off
nationwide scam", New York Newsday, Thursday,
September 15, 1992, Business section, page 33).
Insurance fraud
involving psychiatrists treating people who do not want or need
treatment illustrates a more serious underlying problem that
still has not been adequately addressed: Loss of liberty based on
the opinions of psychiatrists rather than on unlawful conduct by
the accused has no place in a nation that claims to respect the
rights of each individual.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has
included representing psychiatric "patients". His
pamphlets are not copyrighted. You are invited to make copies
for those who you feel will benefit.
2000 UPDATE
"The confusing aspect about this is that many adolescents are irritable, aggressive, and impulsive because they are upset about their life circumstances. In recent years some of these teenagers have found their way into psychiatric hospitals, labeled with the diagnosis of bipolar disorder and placed on medications. Some psychiatric hospitals made a practice of admitting adolescents in distress, using the diagnosis of bipolar disorder inappropriately in order to increase their billing to insurance companies. This practice was so widespread that the federal government finally intervened, charging the hospitals with fraud and assessing fines of millions of dollars. Many of these children did not have bipolar disorder at all, but were acting inappropriately because of stresses in their families, with their friends, and at school." Edward Drummond, M.D., Associate Medical Director at Seacoast Mental Health Center in Portsmouth, New Hampshire, in his book The Complete Guide to Psychiatric Drugs (John Wiley & Sons, Inc., New York, 2000), pages 13-14. Dr. Drummond graduated from Tufts University School of Medicine and was trained in psychiatry at Harvard University.
RELATED ARTICLES:
Jury Awards $3.4 million for Unjustified
Psychiatric Commitment - Associated Press article published in Athens,
Georgia newspaper
"Mental illness reform threatens to strap patients, consumers" by Eugene H. Methvin - previously published in National Review magazine under the title "Cuckoo's Nest," July 15, 1996, page 38.
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