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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

#61

Post by maxerickson »

phren0logy wrote: post #60
maxerickson wrote: post #41

Earlier quoted context omitted.

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?

How does malpractice address things like unnecessary tests?

They generally aren't medically harmful, but it sort of sucks for most people to spend money that doesn't need to be spent.

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

#62

Post by sctb »

zero_intp wrote: post #26

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.

We detached this flagged subthread from https://news.ycombinator.com/item?id=14417211. Personal attacks are not OK on Hacker News.

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

#63

Post by brookside »

phren0logy wrote: post #46
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 understand your points, and there have been many appropriate checks and balances introduced to avoid past abuses (which were very real). That said, I have a hard time feeling that allowing a person to go untreated and end up in jail or prison is in their best interest. Here's a quick link about "transinstitionalization": http://www.namisacramento.org/advocacy/docs/Mental%20Health%...

It's a neat categorization to say troubling psychiatric practices are in the past - I don't think it's accurate.

An example apart from how Psychiatry profits from inserting itself into the legal system - we have society-wide acceptance of the chemical imbalance theory of depression - still without evidence. Because this model is a billions-of-dollars money pipeline for drug companies, who take the bad PR on the nose, and ...psychiatrists.

I have written much less than I could, but I find almost everything about psychiatry - it's influences from Freud, etc. to be problematic.

I know there's no chance of swaying anybody personally invested in the field towards this viewpoint. It's like telling a start-up founder they aren't actually changing the world for the better : /

[1] https://joannamoncrieff.com/2014/05/01/the-chemical-imbalanc...

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

#64

Post by psyc »

DanBC wrote: post #35
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.

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_commit…

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.

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

#65

Post by babyrainbow »

mabbo wrote: post #49
babyrainbow wrote: post #25

Earlier quoted context omitted.

>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…

You're coming to hacker news to argue that vaccines are actually a conspiracy? Best of luck with that.

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...

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

#66

Post by pdkl95 »

phren0logy wrote: post #21
psyc wrote: post #20

Earlier quoted context omitted.

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.

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

Does my three day involuntary hold (5150) that became a two week involuntary hold (5250) and then an unspecified (and very probably illegal) wait for an additional 4 days, because "we're waiting for the doctor to release you" count?. (yes, I know, one data point is not an average). I saw that doctor exactly 2 times during that time, for a cumulative total of maybe 3 minutes, who was simply a pusher of the latest (at the time) SNRI. The nurses emphasized it was important to "show compliance" and take their drugs, even though they were wrong and caused serious problems for months.

Why? I apparently offended a psychiatrist when I insisted that escitalopram ("Lexapro") gave me mild/moderate visual disturbances (hallucination). "Lexapro doesn't do that!". Insisting it did, followed quickly with a (probably mildly rude) comment about observation-vs-theory and just-world fallacy only cut the appointment short and started the above stay. The paperwork was sensationalized fiction, with zero basis in reality.

After the first 3 days, the nurses commented every single day about how unusual it was to be allowed (by insurance) such a long stay. Private insurance would never allow the expense, but apparently their scam worked on Medicare.

I never generalize bad behavior into a stereotype. I'll assume your experience has been very different. I'm sure this kind of problem has a lot of variation. My stay was over 10 years ago, and I would like to believe your industry has improved in that time. It might be a good idea to look outside your normal situation with the goal of gaining a broader perspective. It is very hard to regain trust after it has been burned for legitimate reasons. That puts better doctors at an unfair disadvantage, which is unfortunate. This is why it's so important proactively find the "bad apples" and actually fix the situation before bad behavior becomes normalized[1].

[1] http://www.rapp.org/archives/2015/12/normalization-of-devian...

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

#67

Post by phren0logy »

brookside wrote: post #63
phren0logy wrote: post #46

Earlier quoted context omitted.

I understand your points, and there have been many appropriate checks and balances introduced to avoid past abuses (which were very real). That said, I have a hard time feeling that allowing a person to go untreated and end up in jail or prison is in their best interest. Here's a quick link about "transinstitionalization": http://www.namisacramento.org/advocacy/docs/Mental%20Health%...

It's a neat categorization to say troubling psychiatric practices are in the past - I don't think it's accurate. An example apart from how Psychiatry profits from inserting itself into the legal system - we have society-wide acceptance of the chemical imbalance theory of depression - still without evidence. Because this model is a billions-of-dollars money pipeline for drug companies, who take the bad PR on the nose,…

You might be surprised. I also find the reach of industry to be very troubling, and there's a clear incentive for profit. Many of us continue to push back, and demand better evidence. The erosion of federal funding for research is a concerning development, as it leaves much of the funding to industry sources, who are motivated by profit.

In direct response to these kind of concerns, the NIMH has initiated a totally new research framework to study mental disorders: https://www.nimh.nih.gov/research-priorities/rdoc/index.shtm...

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

#68

Post by Ntrails »

maxerickson wrote: post #61
phren0logy wrote: post #60

Earlier quoted context omitted.

What parts are left uncovered by the malpractice system?

How does malpractice address things like unnecessary tests? They generally aren't medically harmful, but it sort of sucks for most people to spend money that doesn't need to be spent.

If it's possible that failure to perform a test which is probably not going to helpful has a large downside for the doctor, and performing it has only got downside for the patient - you'll end up with incentives which clearly dictate excessive testing.

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

#69

Post by tcj_phx »

phren0logy wrote: post #21
psyc wrote: post #20

Earlier quoted context omitted.

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.

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

My girlfriend has had three stays at two different UHS hospitals in Phoenix (UHS is the subject of this ars technica article). They tried to keep her indefinitely the first time. The second two times were unnecessary month-long "stabilizations" that did not address the causes behind her presenting symptoms (self medication with alcohol). At the third stay UHS got her addicted to benzos, which stopped working after a month...

I know you're a psychiatrist, and it seems like you practice in a fairly conventional manner. My experience with the mental health system is that the doctors have good intentions, but have been misled by their training. Because my girlfriend's doctors have inverted cause and effect, they haven't been able to help her get her psychosis-provoking self-medication tendencies under control (they think that psychosis -> drug use, or that alcohol/drug use is a separate condition from her psychotic disorder).

For her first stay at UHS, it took a few days of calls for me to figure out the "magic words" for my girlfriend to say to get them to let her out - this was after about 2 weeks of "stabilization" that was really just getting her used to the tranquilizers. Finally someone told me she had to say "against medical advice", and they let her out two days later.

She started to come out of her zyprexa-maintained psychotic coma after about 3 days, then she resumed self-medicating her physiological imbalances. I knew that alcohol wouldn't help, but I couldn't prescribe what she needed, or force her to take it anyways.

She was under a court order for the second two stays at a different UHS facility, so she was powerless to resist the obsolete theories that they used to worsen her condition.

It is now known that psychosis is related to cortisol deficiency. Cortisol is produced in the mitochondria. Therapies which improve the metabolism are indicated for all mental health patients.

The only helpful treatment that my girlfriend received was getting revived by the fire department (benzos amplify opiates, fyi). Her drinking was under control for about two weeks after those two doses of naloxone. Naltrexone (similar to naloxone) is FDA-approved to help people keep their alcohol use under control.

I was able to verify that my theories were basically correct when she lived with me for about two months. But then she went to visit her mother, and made herself psychotic with the street pharmacy again (bad situation with her old not-friends -> alcohol -> meth amphetamine), and she's back to getting "helped" by professionals who don't care about cause-and-effect.

Robert Whitaker's Psychiatry Defends Its Antipsychotics is a refutation of psychiatry's latest attempt to defend the use of anti-psychotics: https://www.madinamerica.com/2017/05/psychiatry-defends-its-... (May 21, 2017)

I guess I'm just asking you to consider that anti-psychotics are most psychiatric patients' problem, rather than their solution. Since you work with the criminal justice system, you're in a position to do a lot of good for a lot of people.

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

#70

Post by ehnto »

maxerickson wrote: post #61
phren0logy wrote: post #60

Earlier quoted context omitted.

What parts are left uncovered by the malpractice system?

How does malpractice address things like unnecessary tests? They generally aren't medically harmful, but it sort of sucks for most people to spend money that doesn't need to be spent.

Interesting anecdote. My country has public healthcare but you do have to be registered and present a card for it. I didn't have my card once, and the doctor was preparing me for a test when he read on my appointment sheet that I wasn't covered by public health care for that appointment. So he said don't worry about the tests, they are very expensive and I am pretty sure you are fine.

Did the doctor's incentive to run the test when he thought the government was paying lie in the interest of me, the company who does the tests, or the government who wants a healthy populace?

It's hard to know. But I will be honest and say that as I'm paying for just a fraction of it with my taxes, I actually don't mind and if they are being thorough even for the benefit of some medical company's coffer, at least the country can afford to be thorough.

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