
Intake – American's largest psychiatric chain - andy
https://www.buzzfeed.com/rosalindadams/intake
======
DashRattlesnake
> Lauren Singer, who worked for six months at the front desk of Colorado’s
> Highlands Behavioral, said people who were waiting in the lobby for an
> assessment would ask her what it would entail. “I would frequently get
> yelled at for overstepping my bounds and telling them too much about the
> evaluation process,” Singer said. A button behind the receptionist’s desk
> controlled the lock to the front door of the facility, and, she said, “If
> someone came in voluntarily, I wasn’t allowed to let them out of the door.”

That's terrifying. Earlier in the article they talked about people coming in
for simple depression screening based the hospital's ads, but things like
locking the doors behind people who choose to come in are probably keeping a
lot of people from getting the help they need.

Medical care, especially medical care with an involuntary component, should
never be for profit. The profit motive is just too corrupting.

~~~
maxerickson
There can be pernicious motives whether a facility is nominally for profit or
not.

(For instance, say there is a doctor who gets paid in proportion to the time
they spend treating patients at a non profit facility)

~~~
omginternets
>There can be pernicious motives whether a facility is nominally for profit or
not.

This is colloquially known as "whataboutism".

The fact that there are _other_ pernicious motives is completely irrelevant.
For-profit medicine constitutes a pernicious motive -- that's the point.

~~~
maxerickson
Well, I don't agree with that. I see generous salaries as being exactly the
same thing as profit (they are just taxed differently). I also have difficulty
with the idea that only de facto agents of the state can deliver healthcare
(care only available at fixed prices, etc).

So my point is that you need external controls regardless of the motivations
of the actors inside the institution.

~~~
rounce
> I also have difficulty with the idea that only de facto agents of the state
> can deliver healthcare (care only available at fixed prices, etc).

It seems that they aren't the only difficulties you have. In a social health-
care system, possession of a medical license doesn't entail one's employer.
You're more than welcome to set up private practice, though you'll have less
chance of the career defining cases, as the majority of patients will not be
using your one-man-band practice. Thus many doctors in the UK, split their
time between their private practice and public services. The only thing that's
"de-facto" is the need to be qualified to treat people.

~~~
maxerickson
It's implicit in the argument I replied to that the side practice better not
deliver excess economic benefits (profits!) compared to working in the public
facilities.

------
0xcde4c3db
Based on my experience as a patient (not at a UHS facility, as far as I can
tell) I'm pretty confident that the stuff reported in this article is just the
tip of the iceberg. These facilities are structured in a way that makes people
doubt their own memories and feel powerless, even before the neuroleptics come
out. Treatment "progress" is predicated on -- if not synonymous with --
submission. I was put on suicide watch after having a bad night's sleep and
complaining that my experience had been harmful rather than helpful. I found
out later that the psychiatrist had written in my file that I'd had psychotic
episodes, which never happened (I'm torn on whether to attribute this to error
or falsification). I've thought about challenging this, but I wouldn't even
know where to begin, and I'm fairly certain it would just end up being my word
against his and not actually doing any good. Basically, the playing field is
heavily tilted against reporting misconduct. For every person Buzzfeed was
able to find, there are probably ten who didn't feel like they could speak out
about it, or convinced themselves that they were just being irrational since,
after all, they were literally a mental patient.

~~~
warfangle
Heres one who hasn't spoken out.

I'm glad that I was able to get appropriate treatment (15 years later) but how
I was treated as a teenager in a mental health facility was atrocious.
Misdiagnosis, over medication, and only keeping patients as long as their
insurance held out was par for the course.

~~~
jessaustin
TIL, contrary to recent political claims, there are some situations in which
it's _better_ for one's health insurance not to cover mental health.

~~~
warfangle
A product of misaligned incentives caused by profit-driven healthcare
industry.

------
rm_-rf_slash
American asylums are a perfect example of the sin and corruption at the root
of American society: dehumanizing and illegal detainment of human beings to
preserve power and profits.

...

In the 1970s, a researcher sent fake (healthy) patients to asylums. They were
loaded with powerful antipsychotics and not allowed to leave until they faked
the cures the psychologists expected to see.

When the fake patients were all out the story blew the lid on the American
psychological profession, so the psychologists said "bring more fakes, we can
sort them out."

The original researcher said "sure."

The psychologists proudly stated a few weeks later that they had weeded out
several dozens of "fakes."

There was no second fake cohort.

[https://en.m.wikipedia.org/wiki/Rosenhan_experiment](https://en.m.wikipedia.org/wiki/Rosenhan_experiment)

~~~
openasocket
I can't speak about asylums in the 70s, but I think modern mental health
centers have problems, some different, some similar. First is that these tend
to be either state-run or contracted, and there is a great incentive to
provide the bare minimum of care. There is also a serious issue with
organization. My father used to work at some of these institutions. He's a
psychologist with a PhD and 20+ years of experience treating the mentally ill.
His bosses, who are in charge of running the place and determining policy, had
high school educations. The nursing staff, who spent most of the time with the
patients, also had high school education (maybe some nursing school education,
but usually not). I think we should increase funding for mental health
clinics, and put the professionals in charge.

Also, I understand the aversion many people have to even the concept of
asylums, but the problem is in the implementation, not the concept. De-
institutionalization is great, asylums should be an absolute last resort and
many cases can be more easily dealt with in out-patient care or medication.
But, absolute de-institutionalization means the mentally ill wind up homeless
or in prison.

~~~
DanBC
There's also a problem that the money saved by closing the big institutions
wasn't put back into better community (outpatient) care. So people have to be
acutely unwell to get any treatment. People with chronic problems don't get
the treatment.

~~~
warfangle
A lot of really good therapists don't accept insurance. A lot of really good
psychiatrists don't take insurance.

Insurance covers on average two sessions of therapy annually.

Therapy is only effective over long periods (years) of regular
(weekly/biweekly) sessions.

It's a fucking travesty.

I spend close to $500 per month, after insurance, for my mental healthcare.
This is a therapist and a psychiatrist.

None of this is covered by my insurance.

I pay what I can with an FSA but it's extraordinarily exhausting.

------
gumby
By the way let's not forget this is excellent investigative reportage by
Buzzfeed who is using their clickbait revenues to do real journalism.

~~~
cylinder
Is there a business model behind it or just prestige? These types of articles
definitely lose money for BuzzFeed.

~~~
gumby
I believe Peretti has made repeated claims dating back to the founding of the
company that this was the plan. Either he's committed or doesn't want to be
legitimately called a liar :-)

All joking aside: so far they've done good work and I assume it is earnest.

------
MrBingley
> “Your job is to get patients,” said a former clinician at Salt Lake
> Behavioral. “And you get them however you get them.”

> Two dozen current and former employees from 14 UHS facilities across the
> country told BuzzFeed News that the rule was to keep patients until their
> insurance ran out in order to get the maximum payment.

Coincidentally, I was discharged this morning from a psychiatric hospital in
Canada. In a non-profit system, there is no financial motive to keep patients
longer than necessary. Furthermore, hospitals in Canada almost always operate
at capacity to keep costs low. This is a double-edged sword of course, but it
means doctors have an incentive to help their patients recover so they can be
discharged to make room for new arrivals.

~~~
djsumdog
On the flip side, the state run facilities in the US always try to push people
out or, "get them back on their feet."

I had a swimming instructor who told me her brother was mentally ill and was
in and out of these all the time. He'd feel he'd need to stay there a few more
weeks, but they'd push him right out. He'd do okay for a while, then stop
taking his meds (because most of those meds do make you feel like shit), then
he'd start having delusions again.

Eventually he'd be back to begging for 40ozs and eventually be back in the
center. America's system doesn't provide enough funding, not just for mental
health, but all the other services around health to help people out and be
self sustainable in their communities.

~~~
rounce
Sadly for people who are like the man you mention, "a few more weeks" is in
actual fact a lot longer. The problem is more likely to be the lack of a
proper support network to help this individual care for themselves in the
long-term, as well as helping maintain routines and structure in their life.
This is not something that can be done in an environment as tightly
constructed as a mental institution. It requires a combination of
professionals and friends on the outside, who are able to give this person
round the clock support to help deal the the complexity of life in a
uncontrollable environment.

Unless we (as a society) can find a way to provide this for those who have
been pushed to the fringes of reality, there will still be a significant
portion of people pushed into the Treat-Release-Repeat loop for years to come.

------
Avshalom
So, I don't know that this is universally "a thing" but when I had a 3-5 hour
break down in June I got in contact with the University of New Mexico's
SHAC[1], I was registered but not yet taking a class and I think its open to
the general public. They give you a little 10-15 minute "counseling triage"
and then give you an appointment or whatever as they feel appropriate.

If you feel like you're in a bad place I encourage you to call your local
university. _Even if you aren 't a student_: schools are extremely used to
dealing with people who don't know how to get started with the mental health
(or any health) industry and they won't fucking kidnap you.

[1] [http://shac.unm.edu/](http://shac.unm.edu/) they accept any one by the
way. Please look for help if you feel like everything is awful, even if it's
just finding some one to talk to.

------
Keverw
It is so crazy how doctors can just lock people up and drug them. No trial, no
right to an attorney, not even a one phone call always... Someone who just
murdered someone and went to jail has more rights than these doctors give
people.

Personally, I think a majority of the mental health industry is a fraud. These
are the same people who voted that being LGBTQ is a mental illness in the DSM.
:( Plus they don't even have blood testing like the majority of doctors can
use as a test.

Then they over diagnosed kids and drug them, as a result of the one size fits
all and boring education system - which promotes testing and memorization over
charter and critical thinking.

------
matheusmoreira
Yeah, after reading all this, I wouldn't blame those patients if they didn't
trust healthcare professionals anymore. It's clear these people don't have the
patient's best interests in mind.

Locking the doors behind people coming into the hospital voluntarily? I wish
they were making this up.

------
a3n
I immediately went to their web site, and looked for their facilities near me.
There are two, and a third in the region.

I hope I remember not to go there in a crisis.

~~~
fineIllregister
What you want is a Psychiatric Advance Directive. It's a way to outline your
wishes for treatment before you have mental health care crisis.

[http://www.nrc-pad.org/](http://www.nrc-pad.org/)

------
spitfire
This would make two incredible movies.

First a horror movie about false involuntary admittance.

Second, a fantastic corporate drama ala michael clayton about the corporate
hierarchy that built, runs and protects the machine.

If anyone writes the screenplay for these, I want royalties.

~~~
jessaustin
"Changeling" is one movie that portrays involuntary psychiatric admittance,
although in that case it wasn't motivated by profit.

------
tcj_phx
Psychiatry in America is an ongoing "crime against humanity". The third world
gets better results for their mental health patients because they can't afford
the pharmaceutical industry's FDA-certified psychotropic medications.

In October 2016 I found videos of my friend before the first hospital. She
quipped about alcohol and drugs, but sounded "normal". We were frying donuts.

About two weeks after the videos were filmed, my friend ran out of alcohol.
Her mother called the "crisis team", who took her to the hospital. I don't
know what happened, exactly, but I assume they treated her with Haldol, an old
cheap "tranquilizer" that is sold to patients as an "anti-psychotic".

But... It's been known since the late 1970's that anti-psychotics make
psychosis worse over time. Robert Whitaker wrote "the case against anti-
psychotics" [1] to provide as succinct a case against this class of drugs' use
as possible.

[1] [https://www.madinamerica.com/2016/07/the-case-against-
antips...](https://www.madinamerica.com/2016/07/the-case-against-
antipsychotics/)

After being given this psychosis-provoking drug, my friend was diagnosed as
"persistently disabled." This diagnosis (professional opinion) is disproved by
my videos, but these have never been viewed by any judge.

Anti-psychotics are also known to make cocaine users more likely to use
cocaine, which is known to cause psychosis. Alcohol withdrawal is also a known
cause of psychosis [2]. My friend told the psychiatrists that she'd been
drinking 2 bottles of liquor a day (methadone side effect, I think), and using
cocaine, but they gave her anti-psychotics anyways.

[2] [https://en.wikipedia.org/wiki/Substance-
induced_psychosis#IC...](https://en.wikipedia.org/wiki/Substance-
induced_psychosis#ICD-10)

My friend escaped briefly from her court-ordered medications in March 2016....
Then she was given an SSRI "anti-depressant" in May 2016, which caused much
anxiety, which led to her getting arrested... She's now being forced to take
tranquilizers again.

I'm still trying to protect my friend from her doctors. When a petition to the
court is dismissed "without prejudice" it means that you can correct the
errors and re-file. I've re-filed twice, but I don't think the judge even read
the second and third petitions. I guess I'm going to the court of appeals
next... <sigh>

edit 1: clarification... edit 2: added the paragraph about getting ordered by
the court to submit to psychiatry. edit 3: added sentence about the third
world

edit 4: Oh my... This buzzfeed article is about "Universal Health Services".
My friend stayed at two of their locations:
[http://www.uhsinc.com/locations/uhs-facilities-map-
usa/](http://www.uhsinc.com/locations/uhs-facilities-map-usa/)

edit 5: I actually went to talk to an investigator with the state attorney
general's office this morning - his department was "health fraud and abuse".
He was not optimistic of being able to find something to investigate. I'm
going to print this buzzfeed article and take it over.

edit 6: forgot to include link for [1]

~~~
bbarn
Good luck, in all seriousness. The article is fresh, and maybe it's recentness
will help you win over the AG office.

------
maxxxxx
They only need to merge with a private prison operator and you have the
perfect customer pipeline.

------
6stringmerc
Great to see the Investigative, Serious Business arm of Buzzfeed get linked
here (I don't visit their site often but know of their growing legit digging).
A sensitive, yet salacious type of subject that can use a spotlight in my
opinion. Simply put, I hope for improvement.

One of the first films I ever watched with my Dad was "One Flew Over The
Cuckoo's Nest" partly because it's part of his life history (grew up in Pac
Northwest, ran into Ken Kesey a few times) but also because of the amazing
life lessons within. The book is even more epic and deep. And, growing up in
the US, I know mental health is still not quite up in the priorities as much
as, well, look at commercials, there's a glut of dick-pills for sale.

I'm a proponent of using fiction to help re-package heavy, important lessons
that journalism brings up. I'd written a short treatment years ago about a
serious PhD Psychiatry student discovering most everybody in the "profession"
at his Public/Private Treatment Center suffered from their own DSM-diagnosable
serious mental illness. From macabre understanding we're all flawed might come
enlightenment. Or, you know, just comedy.

------
Unbeliever69
They are like the ITT of the psychiatric care industry.

------
adolph
There was an interesting Diane Rehm show about involuntary psychiatric
admission recently. It seemed a bit better balanced than the Buzzfeed piece
since it wasn't focused on the apparent misdeeds of a particular organization.

[https://thedianerehmshow.org/shows/2016-11-29/the-debate-
ove...](https://thedianerehmshow.org/shows/2016-11-29/the-debate-over-
involuntary-psychiatric-treatment)

------
gonmf
There should be a special place in hell for people who abuse the most
vulnerable of people.

~~~
throwanem
There is.

------
JumpCrisscross
Are there any UHS locations in New York State or California?

------
cs702
_" Current and former employees from at least 10 UHS hospitals in nine states
said they were under pressure to fill beds by almost any method — which
sometimes meant exaggerating people’s symptoms or twisting their words to make
them seem suicidal — and to hold them until their insurance payments ran
out."_

Don't worry, free-market ideologues will coolly tell you. Their logic will
seem airtight: over time, if Intake's psychiatric wards were really, truly
locking up sane people who don't want to be locked up, the reputation of these
facilities would no doubt have already suffered by now, and the company would
have already been forced to close them. These incidents can only be isolated
cases, regardless of the evidence. The profit motive will keep the company in
check.

If you believe that, you haven't read the article.

~~~
dang
You've introduced an ideological talking point in order to refute it, but
that's the sort of tangent we ask people _not_ to introduce into divisive
threads, because they usually turn into generic arguments/flamewars that
overwhelm the (far more interesting) specifics of a story.

~~~
cs702
dang: that wasn't my intention, but rereading what I wrote, I must admit
you're right. The story upset me and I overreacted. Please feel free to
delete/hide my comment. I added a note to prevent upvoting for now.

~~~
dang
I'd never delete an exchange with so exemplary a recovery :)

------
fizzbang
I have a (relatively minor) nit-pick with some of the language in the article.

Early in the article the author writes "Current and former employees from at
least 10 UHS hospitals in nine states said they were under pressure..."

However, a few paragraphs later she writes "But scores of employees from at
least a dozen UHS hospitals said those facilities tried to keep beds filled
even at the expense..."

I don't understand why the employees are from "at least" a certain number of
hospitals, unless her sources were unclear about where they worked. And why
does this number change?

~~~
projektfu
As you're learning about the story, you might hear a few things "on
background, off the record." That means that you can't really act like you
were told that, but you now know that you have a story. So, you start
reporting, and over time you get employees asking for anonymity from 10
hospitals to say such and such, and from 12 hospitals to say another thing,
and you heard some of this on background. So you can say "at least" but you
can't say the full number. If there is a libel or defamation lawsuit, your
sources can be reviewed under seal, but since you don't note the source of
your background information, you can't state that those sources exist.

------
petulanta
I should hope this comes as no surprise to anyone. Every single psychiatrist
I've ever visited had the same policy, only their lock was medicine rather
than a door (outpatient vs inpatient). I feel bad for the lady because she
didn't know any better and joked about suicide, but shouldn't it be common
sense you don't tell anyone about that--you don't even joke about it--
_especially_ to a doctor with the power to commit you? I'm pretty sure you
can't have decent therapy if you're not truthful with your therapist, but
that's the catch-22 of needing mental help in America. Fucked if you don't
seek it out and really fucked if you do.

~~~
DashRattlesnake
> but shouldn't it be common sense you don't tell anyone about that--you don't
> even joke about it--especially to a doctor with the power to commit you?

It _shouldn 't_ be, because doctors should have the sense and motivation to
differentiate a joke from a true statement.

It's just a really sad statement that our society has traps like this (that
people really need to be aware of), which can really screw you over.

~~~
jrnichols
The problem is that one person that tells you they're just joking and actually
goes out and commits suicide. Then it's on you, the healthcare professional.
Lawyers would ruin you in court.

I've been in and out of various psychiatric facilities, including that very
same facility in Arlington, and it seems like a lot of the policies &
procedures are to cover themselves legally.

Oh, I've been there as a Paramedic, not as a patient. Almost forgot that bit.
We typically bring people in the front door. Even voluntary admissions. The
one thing that struck me as odd is that Millwood always has someone (a LCSW or
something) come out and talk to patients there in the lobby some before having
them sign any of the admission paperwork. They don't lock you in a room and
_then_ have you sign.

