The Profitable Business of Holding Patients Against Their Will

Acadia Healthcare has emerged as a large for-profit player in the mental health care field, filling a gap as non-profit and government providers step back. This shift has placed greater emphasis on profit-driven motives that may conflict with the quality of care offered to vulnerable patients.

The emergence of large for-profit players like Acadia in the mental healthcare market, as traditional non-profit and government providers have stepped back

With the retreat of traditional nonprofit hospital systems or the government from mental health care, Acadia Healthcare entered the market seizing the opportunity. Acadia started in 2005 and went public in 2011, proceeding to take advantage of the Affordable Care Act's expansion of insurance coverage for mental health care. The influx of insured patients provided Acadia with the resources needed for rapid expansion, and the company's valuation has reached $7 billion while operating across 19 states.

Acadia's business model prioritizes maximizing profits over providing quality care to vulnerable patients

Jessica Silver-Greenberg points out concerns about the increasing monetization of healthcare with for-profit companies like Acadia, which could commoditize patients—especially those in mental health crises—leading to subpar and dismissive care.

Acadia indeed places an emphasis on business growth and utilizes aggressive marketing tactics. They reach out directly to potential patients and cultivate relationships with essential referral sources such as police and emergency rooms. Business development teams from Acadia frequently visit ERs with offers of managing challenging patients, using gestures like donut and coffee deliveries to promote their services.

However, there is a concerning blurring of lines between patient care ...

Acadia is under scrutiny for deploying various tactics aimed at extending patient hospital stays for financial gain, often placing financial metrics over clinical care.

Acadia deploys various tactics to extend patient stays

Acadia hospitals have been accused of using a range of strategies to keep patients hospitalized beyond medical necessity. State health inspectors discovered that workers at an Acadia facility were instructed to avoid using descriptions like "calm" and "compliant" in patient charts, presumably to create a record that justifies longer stays. In some instances, doctors at Acadia hospitals in Ohio and Michigan allegedly made false statements on patients' medical charts to support extended hospitalization.

When it comes to involuntary stays, facilities such as North Tampa Behavioral Health file petitions that a patient needs to be held for longer than the 72-hour legal limit. These petitions effectively allow hospitals to continue billing the patient's insurance up until the court date. Between 2019 and 2023, North Tampa Behavioral filed thousands of such petitions, yet judges granted only about 1% of these requests, underscoring the suspicion that many of these were a tactic to secure additional insurance funds.

Exaggerating symptoms and unwarranted petitions

Meanwhile, charges can reach $2,200 per day for each additional day a patient is unnecessarily retained in the hospital. Such expenses accrue while employees report subtle pressure from management to prolong hospitalizations. They were often nudged to reinterpret patients’ behaviors in a manner that could warrant additional days of care, such as questioning whether a non-suicidal patient might be labeled 'combative' to justify an extended stay.

Acadia prioritizes financial metrics over clinical care

The podcast reveals that within Acadia, there may be an elaborate system designed to exploit insurance by filling beds with insured patients for the longest permissible time. This concern is highlighted by accounts from employees, who claimed that when they recommended discharging patients or transferring them to other facilities rather than to Acadia's own, they faced ...

Kathy McKenzie's experience with involuntary admission to an Acadia hospital is a startling example of what appears to be a systemic issue with forced commitments to mental health facilities.

Kathy McKenzie, a social worker with bipolar disorder, was involuntarily admitted to an Acadia hospital despite not posing an imminent danger to herself or others

Kathy McKenzie, a school social worker from Wesley Chapel, Florida, who lives with bipolar disorder, expected a brief visit to the hospital to assess her bipolar medications. During an evaluation at North Tampa Behavioral Health, an Acadia hospital, she stated she had no suicidal or homicidal thoughts which were noted in her medical records. However, despite her clear answers and understanding of involuntary commitment laws, she began to fear she might be held against her will.

Indeed, Kathy ended up being involuntarily institutionalized. She asked to use the restroom and found herself locked in a room with other patients. McKenzie screamed for her paperwork, insisting on being wrongly held. She was placed in a room with another patient on suicide watch. Her belongings were taken, and she was given a single sheet to jot down phone numbers but was denied permission to make calls.

Throughout her ordeal, she repeatedly demanded her rights, records, and the opportunity to communicate with her family. The hospital staff saw Kathy’s attempts to assert her rights as problematic or disruptive, with some referring to her as a "hot one" or hinting that she would "cause trouble."

Kathy developed coping mechanisms during her stay, such as saying the serenity prayer and trying to comfort herself by curling up. Utilizing a pen and journal she acquired after two days, she documented her experience, fearing the loss of her possessions. Her involuntary confinement made her fear for her career and life.

Kathy's experience left her traumatized, with long-lasting effects of PTSD, nightmares, and distrust of the mental h ...

Jessica Silver-Greenberg and Kathy McKenzie’s experiences reveal a concerning lack of accountability and consequences for for-profit psychiatric facilities, despite an ongoing history of complaints and significant red flags.

Regulatory agencies and government oversight have failed to meaningfully address the systemic issues at Acadia and other for-profit psychiatric hospital chains, despite years of complaints and red flags

Despite years of complaints and red flags at facilities like Acadia, regulatory agencies and government oversight have largely failed to take meaningful action to address the systemic issues. Jessica Silver-Greenberg expresses skepticism about any real consequences for Acadia or similar institutions due to little change following numerous reported incidents.

Protection and advocacy agencies, funded by the government to monitor these facilities, have limited authority and have struggled to effectively intervene in real-time situations like Kathy's

Protection and advocacy agencies, despite being funded by the government to monitor facilities that care for vulnerable populations, have limited authority. These agencies struggle to intervene effectively in real-time situations, as was the case with Kathy McKenzie. Kathy's case ended with her release just before a judge's decision was made, concluding her distressing experience at Acadia after approximately one week.

The lack of consequences for Acadia's profit-driven practices raises concerns abou ...