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Feds probing psychiatric hospitals for locking in patients to boost profits

arstechnica.com

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Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#51

Post by will_brown »

roninb wrote: post #36
phren0logy wrote: post #21

Earlier quoted context omitted.

I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.

Could you possibly do the same for your numbers: "less than 4 days"? I trust that you're a psychiatrist but you could be spewing old or incorrect numbers just as easily as anyone else who may unknowingly make a mistake.

In Florida we have the Baker Act, which is common knowledge in FL outside even mental healthcare circles, and is a 72 hour involuntary institutionalization for examination.

https://en.m.wikipedia.org/wiki/Florida_Mental_Health_Act

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#52

Post by phren0logy »

yourapostasy wrote: post #44
brookside wrote: post #38

Earlier quoted context omitted.

Firstly, it must be incredibly difficult to work with severely mentally ill populations, so I commend and thank you for taking on that responsibility. It troubles me, however, to to give a government the capability to detain citizens based on the (forgive the scare quotes) "medical" expertise of a psychiatrist. This has been abused [1] and I find significant issues with the credence given to testimony by psychiatrist…

> I'm not sure the answer here. Has anyone started making lots (like tens of thousands) high-resolution, 3D, video ( i.e., not still snapshots, but over time and ideally during episodic moments) MRI and CAT scans of diagnosed psychiatric patients, pointed a deep learning system at the scans, and see if patterns can be detected? If the deep learning systems can pick up patterns we didn't notice before, then that could…

Yes, but this is expensive and difficult, and not many people volunteer to participate.

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#53

Post by outlace »

DarkKomunalec wrote: post #24
Jare wrote: post #23

Earlier quoted context omitted.

> 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.

Necessary or not, no institution should have the power to imprison without all the safeguards of a criminal trial.

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.

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#54

Post by brookside »

yourapostasy wrote: post #44
brookside wrote: post #38

Earlier quoted context omitted.

Firstly, it must be incredibly difficult to work with severely mentally ill populations, so I commend and thank you for taking on that responsibility. It troubles me, however, to to give a government the capability to detain citizens based on the (forgive the scare quotes) "medical" expertise of a psychiatrist. This has been abused [1] and I find significant issues with the credence given to testimony by psychiatrist…

> I'm not sure the answer here. Has anyone started making lots (like tens of thousands) high-resolution, 3D, video ( i.e., not still snapshots, but over time and ideally during episodic moments) MRI and CAT scans of diagnosed psychiatric patients, pointed a deep learning system at the scans, and see if patterns can be detected? If the deep learning systems can pick up patterns we didn't notice before, then that could…

Maybe somebody could get ahold of Dr. Daniel Amen's data. Amen (almost an actual phrenologist!) also makes another great example of prominent nonsense in the field. https://www.washingtonpost.com/lifestyle/magazine/daniel-ame...

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#55

Post by phren0logy »

hashkb wrote: post #32
phren0logy wrote: post #21

Earlier quoted context omitted.

I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.

Will you provide citations for everything you said in your comment?

This is a totally fair request, but I am also super busy. Is there any point in particular I can get you some references about?

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#56

Post by yourapostasy »

phren0logy wrote: post #52
yourapostasy wrote: post #44

Earlier quoted context omitted.

> I'm not sure the answer here. Has anyone started making lots (like tens of thousands) high-resolution, 3D, video ( i.e., not still snapshots, but over time and ideally during episodic moments) MRI and CAT scans of diagnosed psychiatric patients, pointed a deep learning system at the scans, and see if patterns can be detected? If the deep learning systems can pick up patterns we didn't notice before, then that could…

Yes, but this is expensive and difficult, and not many people volunteer to participate.

"Yes this should be tried", or "Yes, someone has started doing this"? If the latter, can you please post a link to their effort?

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#57

Post by phren0logy »

yequalsx wrote: post #43
phren0logy wrote: post #21

Earlier quoted context omitted.

I don't know of anywhere that has average stays anywhere near a month. Please provide a citation.

Well how about the article in question? It doesn't say a month but the gist of the article is that profit is motivating at least one chain to make patients stay too long. Which is the essence of the point you are responding to. My wife is an inpatient psychiatrist. She gets a monthly productivity report. Her pay is based on the productivity. In her system she gets more money on the day of admission than for subsequen…

I worked at an inpatient hospital that had monthly productivity reports. My salary was totally independent of them, and I still quit after a few months because I didn't like the implication. I would encourage your wife to do the same. For most of us, that's not why we went to med school.

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#58

Post by lfowles »

jstanley wrote: post #13

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.

Don't read this before bed then:

https://en.wikipedia.org/wiki/Rosenhan_experiment

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#59

Post by phren0logy »

yourapostasy wrote: post #56
phren0logy wrote: post #52

Earlier quoted context omitted.

Yes, but this is expensive and difficult, and not many people volunteer to participate.

"Yes this should be tried", or "Yes, someone has started doing this"? If the latter, can you please post a link to their effort?

http://journals.plos.org/plosone/article?id=10.1371/journal....

Re: Feds probing psychiatric hospitals for locking in patients to boost profits

#60

Post by phren0logy »

maxerickson wrote: post #41
phren0logy wrote: post #16

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 sui…

I wonder if there is a way to setup the system so that a corrupt doctor that has lost their way is still mainly incentivized to work for the interests of the patient. Even in medical situations where patients do not face involuntary confinement, they are mostly left wondering if the doctors are working for them or working to bill them (I guess the outcome based payment schemes address this).

What parts are left uncovered by the malpractice system?
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