Feds probing psychiatric hospitals for locking in patients to boost profits • Hacker News Board

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

#71

Post by ehnto » Thu, May 25, 2017, 4:30 PM UTC

Ntrails wrote: post #68

maxerickson wrote: post #61

Earlier quoted context omitted.

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.

Test Driven Doctoring? Or perhaps they are practicing Defensive Doctoring.

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

#72

Post by comex » Thu, May 25, 2017, 4:55 PM UTC

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,…

> 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.

Are you just referring to overuse of antidepressants caused by that theory, or are you suggesting that antidepressants don't work? Because there's good evidence that at least in severe cases of depression, antidepressants do work and are more effective than other therapies alone. [1] Even if we don't really know how they work…

[1] https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2...

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

#73

Post by tcj_phx » Thu, May 25, 2017, 6:01 PM UTC

psyc wrote: post #64

DanBC wrote: post #35

Earlier quoted context omitted.

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…

Everything you say here is basically what I've observed.

> Unfortunately, justice is glacial, and the law doesn't protect you in the short term.

I got a court order freeing my girlfriend from the first hospital in a day and a half. Then I made the minor mistake of returning to the hospital without a police escort, and they succeeded at sucking her into the system. It's been slow-motion anti-justice ever since.

> 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.

Thanks for sharing this. My current case is in the court of appeals, and is probably going to take another 3+ months. This is something I can do to hopefully get the treatment providers to stop their palliative treatments more promptly.

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

#74

Post by hashkb » Thu, May 25, 2017, 6:04 PM UTC

DanBC wrote: post #39

hashkb wrote: post #33

Earlier quoted context omitted.

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?

> 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.

I assume anyone who works in mental health is familiar with the basics of empathy. Yes, I am familiar with the difference. I believe psychiatry is a subclass of psychology.

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

#75

Post by hashkb » Thu, May 25, 2017, 6:05 PM UTC

maxerickson wrote: post #34

hashkb wrote: post #33

Earlier quoted context omitted.

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?

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.

See my reply to the other comment that said what you said.

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

#76

Post by DanBC » Thu, May 25, 2017, 6:14 PM UTC

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.

> They generally aren't medically harmful

Over testing is harmful, especially when it causes over diagnosis and over treatment.

People die from this.

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

#77

Post by DanBC » Thu, May 25, 2017, 6:19 PM UTC

will_brown wrote: post #51

roninb wrote: post #36

Earlier quoted context omitted.

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

That's the assessment detention. After that there's a possibility of further detention for treatment.

> a petition for involuntary inpatient placement (what some call civil commitment),

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

#78

Post by thatcat » Thu, May 25, 2017, 6:22 PM UTC

babyrainbow wrote: post #65

mabbo wrote: post #49

Earlier quoted context omitted.

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…

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?

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

#79

Post by pc2g4d » Thu, May 25, 2017, 6:29 PM UTC

brookside wrote: post #38

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…

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…

The Finnish "Open Dialogue" approach is an interesting alternative. It's more about family and community integrated treatment than residential commitment. Recommended search: https://www.google.com/search?q=finland+open+dialogue

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

#80

Post by mistermann » Thu, May 25, 2017, 6:48 PM UTC

mabbo wrote: post #47

mistermann wrote: post #22

Earlier quoted context omitted.

Or visit emergency in most any Canadian hospital.

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.

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.)