Health Care/Joan Retsinas

There is Money in Misery

Since COVID, Americans’ overall mental health has plummeted. A lot of us suffer from depression, anxiety, substance abuse — a gamut of diagnoses. The causes are not so much biologic as social.

The pandemic-fueled lockdown shocked most psyches: We need everyday interactions with others, from friends to acquaintances to colleagues. Knowing that if we left our homes, we risked death contributed to the despair. Add the trials and uncertainties of everyday life: Will my job pay off my $100,000 in student loans? Will I pay off my credit card debt? Will I find a house I can afford near my workplace? Will I have good-enough health insurance to pay for treatment? Will my children go to safe — let alone adequate — schools? The CDC has said that parenting today poses a major public health menace — simply too stressful. The specter of a warming planet hovers. And now when our beloved Labradoodles and dachshunds run away, we have to fear that a dark-skinned immigrant is barbecuing them.

It is no surprise that the measures of mental illness have risen.
Similarly, it is no surprise that a lot of people are seeking help. They need help. And as a nation is behooves us to help them.

So the demand for psychiatric social workers is up. Ditto for psychiatrists, for psychologists, for substance abuse counselors, for mental health counselors. The Bureau of Labor Statistics forecasts robust growth in those jobs. Psychiatric facilities report a shortage of inpatient beds.

Not to worry: Private capital has rushed in to save us.

The newest burgeoning industry: for-profit psychiatric hospitals. But these are not free-standing ones. They are “partnering” with nonprofit hospitals.

The grafting is clever. A nonprofit hospital wants money. In fairness to the auditors, the nonprofit is supposed to give money back to the community — the perk that justifies its nonprofit status. (Of course, the perk is arguable since nonprofits, like their for-profit counterparts, still hone in on the bottom line.) So the nonprofit hospital wants to bolster its revenue, but sees no easy solutions: it is not going to draw private-paying patients who can pay the full tab; it is unlikely to lure more donations; it has wrangled as much as it can wrangle from the nation’s insurers, private and public. The dilemma challenges the MBA-management.

The managers have a solution: Graft onto the nonprofit a for-profit branch — especially artful if the branch cannot thrive on its own. For the nonprofit hospital, the newly diagnosed patients who present with mental health emergencies also present as patients, a.k.a. sources of revenue; yet the nonprofit would need to add specially trained staff to treat, and bill, these patients. The solution is ingenious, almost a symbiotic grafting: a nonprofit hospital grafts onto its revenue stream a private psychiatric hospital, especially one so beset with scandal that it is seeking a host-trunk. To add to the success, the nonprofit does the graft secretly, so that patients, entering the doors of Nonprofit Hospital, do not know that they are entering the branch operated by For Profit Psychiatric Hospital. (Stat: Troubled For-Profit Chains Are Stealthily Operating Dozens Of Psychiatric Hospitals Under Nonprofits’ Names.) Only when patients complain to the hospital do they discover that they were admitted to a private psychiatric hospital.

If only those hospitals didn’t see those patients primarily as sources of revenue, this would not be a problem. After all, people need care; the psychiatric hospitals presumably can give that care.

But investors want profits. The patients generate revenue. So the recent New York Times exposé, “How a Leading Chain of Psychiatric Hospitals Traps Patients” (Sept. 1, 2024) by Jessica Silver-Greenberg and Katie Thomas into Acadia Healthcare’s entrepreneurial zeal is not surprising. The best way to “maximize” insurance payments is to prolong patients’ stays — not to return the patients to the community quickly. “Successful” treatment is not a good business strategy: The Times discovered that one hospital in Florida was even holding patients against their will.

As a nation, we can bolster the mental health of our citizens without filling the coffers of investors. Government — the demon of Project 2025 — can help. Consider the omnipresent violence besetting schools, workplaces, shopping malls. We are all chagrined, frightened. But the government can outlaw the automatic weapons easily acquired, recently used in massacres. The government can impose sane regulations. On to housing woes. The government can spur the production of more units, rental and owned. Urban schools often pale in “quality” beside their suburban counterparts. Communities can invest in education, so that all schools are excellent. The government can expand Obamacare, can extend Medicaid (states’ zeal to pare the rolls has left thousands of Americans without insurance). A forceful government can lower the cost of drugs (as it did with insulin). The government can raise the minimum wage, giving more Americans a boost out of poverty.

Beyond government, though, we ourselves can stop the libelous hate-filled rhetoric that divides us.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.

From The Progressive Populist, October 15, 2024

Populist.com