top of page

A reaction to “The Profitable Business of Holding Patients Against Their Will”

René Nicoletti

By René Nicoletti, LICSW


I recently read an article in the New York Times titled “The Profitable Business of Holding Patients Against Their Will”*. The story highlights how a leading chain of psychiatric hospitals trap patients. The company, Acadia Healthcare Company, Inc., is an American provider of for-profit behavioral healthcare services. It operates a network of over 225 facilities across the United States. Acadia is holding people under the laws meant for people who pose an imminent threat to themselves or others. According to records and interviews, many of the people who are affected by this, do not meet the legal standard. One woman tells the story of how she tried to get her Bipolar medications adjusted, only to find herself locked into an Acadia facility for a week. This experience caused significant distress and PTSD. One of the presumptions in this story of for-profit psychiatrist hospitals is that there are financial reasons to hold patients, as opposed to medical ones. 


When listening to this, I was struck by my own visceral fear of being in a situation like this. Even as a mental health professional, I can imagine falling into this trap while vulnerable and seeking help. Then, there was the realization that I know people in my personal and professional life who have been in adjacent circumstances. One of my clients has suffered significant PTSD from her time being held in a psychiatric hospital. For the sake of her anonymity in this story, I have changed her name. I will call her Maya. 


Maya has dyslexia and ADHD, and she experienced high levels of lead poisoning at an early age. She has Complex Post-Traumatic Stress Disorder (CPTSD) from growing up in an abusive home. Maya was not diagnosed with any disabilities while in school. She was often told she was ‘just lazy’. She was shown off to other students as an example of what not to be. Maya strove to prove her teachers and her dad wrong by getting a college education. While in her final semester, the stress became overwhelming and her symptoms became unbearable. She voluntarily admitted herself to Roger Williams medical center for help managing suicidal ideation and other symptoms. She went in as a coherent and cooperative individual. Roger Williams is a nonprofit hospital. Here, she was admitted to the emergency department for processing before being transferred to the unit for behavioral health. During the initial admit period, she experienced interactions that left her feeling degraded, disrespected and stripped of control. She was not allowed to call loved ones or have a say in medication management. She was not given space to communicate her specific needs meant to avoid triggering severe trauma. 


Maya is someone who already endures chronic mental health issues, and this experience was life altering. It destabilized her for over a year, impacting her ability to go to school, to work, and to take basic care of herself. This young person is smart and ambitious. She is trying to better herself and bring pride to her Latinx community and family. She got out of the hospital with more pain and less answers.


In our professional relationship, we work on managing her symptoms and healing from this trauma. She often asks me, “how could you do that to someone?” She has no justice for the way she was treated, and she has no one to hold accountable. There is also the toll this takes on her family and loved ones. On a larger scale, these events increase community trauma and mistrust for mental health care. This is especially true for communities of color, and it perpetuates the already broader healthcare needs of these communities. Trauma informed care needs to be an elemental component to health services. It is clear that the staff at Roger Williams medical center was unable to provide this for her. 


I am drawn to the ongoing debate around private, for-profit, and nonprofit options for healthcare. The argument for privatization tells us that profit-seeking behavior leads to cost cutting and greater attention to customer satisfaction. That privatization leads to more efficient healthcare delivery by shorter waiting times, shorter hospitalization periods, and quicker surgery access. Nonprofits may not be siphoning money off the top, but they often attempt to undercut prices by sacrificing standards such as quality, safety, and wages. Regardless of the structure, we need more oversight. We need people who are only acting in the best interest of the patients. We need systems that enforce accountability and intervention.


This matters for the health of our society as a whole. Lack of emergency mental health services can lead to escalation in symptoms and potentially result in poorer outcomes. This can cause unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide, and poor quality of life§. It can exponentially increase the symptoms for people of lower socioeconomic status (SES). In many instances, these are the people often filled with dissatisfaction because of the ways they are treated and their limited accessibility in receiving healthcare¶. These influences perpetuate the cycle of oppression and lead to less overall health of a society.


As a clinical mental health professional, I am often helping my clients put out metaphorical fires. These fires always benefit from deeper systemic evaluation. Without which, the problems reoccur. I will end this post with two ideas on what to do. 


First, we (mental health professionals and our society as a whole) need tools to put out fires. The journalist in the article that inspired this post points out that there was a huge influx of individuals reaching out to share their story and ask for help after the story was aired. The suggestion was to reach out to protection and advocacy groups in your state. The Disability Rights Rhode Island is part of the national network of Protection and Advocacy agencies that help secure and advance the rights of people with disabilities. The woman in that article described having an alternative plan in place for her potential future needs. I have, and would advise others, to plan for this before it’s a problem. 


Second, and regardless of where the source of funding is coming from, we need structures that incentivize acting in the best interest of the patients. We also need transparency of cost and effectiveness. Consumers of healthcare should be able to seek and understand data using simple and clear scoring for facilities and providers. 


If this post has resonated with you for personal or professional reasons, please reach out to me. Maya’s story is one of many, and they all matter. Through collective action, we can continue to make changes to our healthcare system and our society. 


 

Recent Posts

See All

1 Comment


Edward Breton
Edward Breton
Oct 16, 2024

This NYT article should put fear in all of us. The first paragraph of the article immediately sends up glaring red flags and warnings of potential abuse - "the company’s revenue has soared. Its stock price has more than doubled." In a world where profitability is often the main goal, where stock prices unjustly influence and even determine medical decisions, we shouldn't be surprised that patients (people!) were held against their will. The glowing profit margines easily cover the cost of attorney's fees that maximizie the length of time patient (person) can be detained (confined). The medical decision of when to take away a person's rights was complicated enough when it was based on what was necessary for the safety…

Like

© 2024 by Take Root Counseling.  Designed by Ironsitemarketing.com

bottom of page