Intake – American's largest psychiatric chain | Hacker News Reader

Intake – American's largest psychiatric chain

buzzfeed.com

241 pointsandy94 comments

> 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.

If these allegations are proven and those responsible for these policies don't spend significant time in prison then we can no longer deny that we live in a corrupt society.

I mean, this sounds a lot like criminal kidnapping.

If abducting someone for profit isn't kidnapping then I don't know what is.

And indeed she reached a settlement with the company which presumably means they were worried about losing a lawsuit or worse.

Why weren't criminal charges pressed? Why is nobody in jail? Holding people hostage is definitely illegal.

Because in the US (at least) if the victim won't press charges the police can't take action. And in a case like this the defence will attempt to attack the (alleged, at the time of the trial) victim's credibility, which can be devastating. It's the main reason why rapists so often get away with it. Also why gang members are hard to convict.

Some crimes don't have a legal victim, e.g. murder (victim is dead) or so-called "victimless" crimes (prostitution, drug possession, speeding, etc).

Kidnapping in the the latter category it does not require anyone to press charges. Assault is the same way as well. If LE has evidence they can move on it. The fact of the matter is prosecutors don't want to risk their win loss ratio.

That's not true. The decision about whether to press charges is up to the prosecutor. The prosecutor will often take the victim's wishes into account when deciding what to do, but they aren't required to.

This is not true. The only person with the choice/authority to prosecute is the prosecutor.

Prosecutors want trophys.

If a victim won't testify, unless there is alt of other evidence, good luck getting a conviction.

So I mean this is all super fucked up but:

http://app.leg.wa.gov/RCW/default.aspx?cite=9A.40&full=true

I suspect If I kept google-ing danger to self or others gives institutions authority to restrain.

http://en.wikipedia.org/wiki/Kids_for_cash_scandal

Feel free to think otherwise, but we are living in a corrupt society. This isn't any news to anybody except those with no experience with any part of the government system.

> then we can no longer deny that we live in a corrupt society

I've not heard anyone denying this. The only thing people like to debate is which aspect - as if it were a binary choice.

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)

That's true, but removing the profit motive of the facility removes one major incentive for coordinated, large scale corruption like this. Other incentives (like production-based compensation being gamed by unscrupulous individuals) will have to be dealt with in other ways.

So without profit, the operating metric will be what exactly?

Er...are you questioning the existential purposes of the non-profit sector in general, or just non-profit healthcare?

Just trying to point out that human action without profit requires something else to account for the costs; otherwise there is no way to judge comparatively how limited resources should be applied. So if there isn't going to be profit driven activity, what will be the metric for success? If it is "outcomes", then we should start plowing everything we've got into it. Of course, should that mean we stop plowing resources into other endeavors? Do we make a vote of it? A law case?

In healthcare we have this amazing thing called "outcomes".

I can see it now:

  "This graph depicting
   revenue reveals that
   the maternity ward is
   quite the cost center. It
   should be going up and 
   to the right!

   Smithers, why are there
   so few pregnancies? We
   need more in-patients,
   otherwise our overhead
   starts eating away at 
   our profits."

  "Well, sir, I suppose 
   there aren't as many
   teen pregnancies as 
   there used to be, and
   with the benefit of 
   modern procedures, the
   pregnancies we do see
   are fairly uncomplicated..."

  "Uncomplicated?! Why,
   everyone knows live
   vaginal births are the
   devil's causeway. Those
   infants can't be as 
   healthy as these so-
   called 'doctors' seem
   to believe. See to it
   that more tests are 
   performed. I'm sure we
   can find something wrong 
   with some of these 
   freeloaders."

...enter Dr. Nick.

  "Hi, everybody!"

You'll just need to have permission before you can get pregnant; cost problem solved (except for the expanding bureaucracy to manage the rules and operations of maternity).

Patient outcomes?

>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.

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.

> 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.

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.

This is completely beside the point. "For-profit healthcare" and "well-paid doctors" are distinct concepts.

Doctors are still very well-paid in France, for instance. It's just that the hospital isn't expected to turn a profit.

I'm arguing that compensation and profit are actually the same thing.

They are both economic benefits from providing a valued product or service. Saying that the one is evil while ignoring the other doesn't make any sense at all. It's the opposite of being beside the point.

Take the case of 2 doctors that have the same price list. One is better at doctoring and sees more patients. Because there is only the other doctor, their faster appointments represent a higher income than the other doctor. The second doctor still manages to provide competent care to all the patients they see, but they are capturing less economic benefit than Dr. Speedy. Is Dr. Speedy evil for charging the going rate?

I believe the GP is arguing that the same exact motives can happen in non-profit hospitals (as in the tax designation). This amounts to (at most) no more than a different route for the profits to those setting these policies. IMHO seeing this as a separate issue makes about as much sense as seeing false advertising to be separate problem depending on whether the corporation files as a C-corp or S-corp.

I for one think it is very important that any attempts to prevent this behavior don't leave loopholes for non-profit hospitals, so keeping this in mind here is actually very important.

People associate everything with the hospital and don't realize that doctors are frequently part of independent practices.

I remember vividly when my grandmother was in an awful hospital in NYC dying, I found the hospitalist to talk about her situation. He claimed to not Treating her and had no idea who was and directed me to another doctor. Yet he was standing at the station, with my grandmother's chart open with marking that he had just added her condition.

He actually told me the truth, but he was sitting there with a stack of files defrauding Medicare. Whatever profit the hospital was or wasn't making, the doctor was ringing his till.

I use the word "incentives".

>should never be for profit.

That may be, but -- as other commenters have noted -- the definition of "for profit" is colloquial and subject to concept creep. A more specific prescription (heh), I think, would be that medical care (or at least involuntary care) should never be subject to fiduciary duty in the sense of Dodge v. Ford.

This is kidnapping plain and simple. The fact that it is done under the guise of a corporate/medical structure should not be relevant. Those involved in these crimes should be arrested and prosecuted under RICO laws, from the top to the bottom.

Sadly, I can see the counter argument. "It's not kidnapping, because someone with mental health issues can't be trusted to make their own decisions." {Cue jury ignoring logic errors and nodding}

Maybe it's currently reading Larsson's books, but mental health issues seem to raise incredibly challenging ethical questions (under economically feasible settings).

Mental health issues may raise incredibly challenging ethical questions, but that's beside the point in this case. There is a legal structure set up for this sort of thing. You don't just lock people in a building against their will for days or weeks without a court order. And you certainly don't choose which people to lock up based upon availability of insurance money.

IMO Matthew Salanger should be facing down charges carrying hard jail time right now.

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.

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.

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.

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

>Treatment "progress" is predicated on -- if not synonymous with -- submission.

This was my experience as well. When I was in holding, a sympathetic nurse told me that to get out of there as soon as possible, I needed to smile, go to all meetings, and do exactly as I'm told. There was a Bible study that I wasn't interested in going to, and another nurse heavily suggested that I attend, which I ended up doing. I felt very powerless throughout it.

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

don't you mean psychiatrists, not psychologists?

It's tempting for some people to think "That was 40 years ago, and it couldn't happen now".

Things are much better (if only because all those big institutions were closed), but we stills see examples.

http://www.independent.co.uk/news/world/americas/woman-held-...

This woman told her doctor that President Obama followed her on Twitter. That's very easy to check, 5 minutes tops. No one checked, they assumed it was a delusion, and she was detained against her will, deprived of her liberty.

The submitted article has some really disturbing parts:

> A technician rifled through Trimble’s purse for sharp objects and then a nurse told her to strip down to her underwear. It was then, she said, that she realized the doors to the psychiatric ward had locked behind her.

> Trimble, who has recently reached a settlement regarding her hospitalization, recalled shaking with fear and “deep, shameful humiliation” as the nurse examined her body, noting the location of any identifying marks. “All you can do,” Trimble said, “is stand there and let it happen.”

There's considerable overlap between "people who've experienced abuse" and "people who have mental illness". You can imagine jut how traumatic this kind of treatment could be to some people.

> 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.

This is bizarre. There's no shortage of people who would have an actual need for those beds.

But there is a shortage of people with (good enough) insurance who would have an actual need for those beds.

The article even indicated this:

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.

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.

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.

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.

If you haven't read the book or seen the movie I'd highly recommend "One Flew Over the Cuckoo's Nest", both are excellent.

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

They've had several excellent investigative articles recently - the investigative group is headed by a pulitzer award winner.

It's like creating cancer to cure it. I'm not sure if that's good or bad.

Well, to be fair, clickbait and yellow journalism far far predates Buzzfeed (e.g. Hearst's apocryphal "you supply the article and I'll supply the war"). And the muckrakers were also click baiters.

But I see your point.

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

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.

> “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.

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.

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.

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/ 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.

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.

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.

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.

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/

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.

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

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...

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...

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/

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]

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

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

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.

They are like the ITT of the psychiatric care industry.

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...

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

There is.

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

"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.

I never fully understood free market ideologies because no market can ever really be "free" in the theoretical sense. "Free markets" are based off of a set of assumptions that can never quite be true.

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.

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.

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

Who are you referring to as free market ideologues? Many purport to be.

An anarco-capitalist (an anti-rand) libertarian flavor) rejects involuntary commitment as a matter of dogma. So these institutions cannot exist, even if they are following the "law".

Furthermore it is the state who has monopoly over violence that legitimizes this behavior (the history of physiology, involuntary commitment, and state violence is rich and fascinating).

Libertarians see this as violence over an individual. Not being the initiator of the violence, the victims have a full moral right to use violent means to defend themselves, up to and including deadly force.

Right or wrong, these "free market extremists" have a more nuanced position than "the market will sort it out"

Yeah, no kidding. We're talking about a situation where one party can coerce another into being a customer by kidnapping and imprisoning them. In what insane universe can you call that a "free market"?

"Free-market", like many -isms may mean many different things to different people.

However, it seems clear that pressure to profit, pressure to grow fast, to raise ever larger rounds, etc. leads to huge missteps, both in tiny startups and in huge corporations. If you replace "beds" in that quote with "bank accounts" you get the Welles Fargo scandal. Ditto for Theranos. And these are only the very recent examples (that we know of).

That would actually be a convincing argument, if it weren't for the insurance coverage (private or government) they repeatedly mention. Seizing the person is just a prerequisite for getting the insurer to write the hospital a check; they're not the customer, they're the product.

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?

I read the "at least" language as more-explicitly leaving open the possibility that the problem exists in more widely in the UHS system.

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.

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.

> 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.

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.

> Every single psychiatrist I've ever visited had the same policy, only their lock was medicine rather than a door (outpatient vs inpatient).

I'm confused, are you complaining about psychiatrists forcing medication on people? I thought the entire point of seeing a psychiatrist was to get on medication...

People also go to psychiatrists to be screened for whether they need medication, likely at the recommendation of a therapist.

It's entirely possible to discuss suicidal ideation with a competent therapist/psychiatrist without being committed.

Sometimes you need to make a cry for help and the only lever you have is saying this.

It doesn't mean that what was said was the actual reason, which happens to often. Not enough follow-up happens, and the original trigger for the call-for-help goes unaddressed.

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