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When Britney Spears stood before a judge in June, she was reluctant when she said she was being forced into psychiatric treatment that cost her $ 60,000 a month. Although the pop star’s circumstances are unusual in a financial conservatory, hundreds of thousands of psychiatric patients are involuntarily treated each year, and many stick to the bill.
Few have the Spears resources to pay for it, which can be devastating.
To the frustration of those studying this issue, there is little data on how many people are involuntarily hospitalized and how much they have to pay for this treatment. From all that can be put together, approximately 2 million patients are hospitalized in the United States each year with drug use or other psychiatric problems, nearly half involuntarily. One study found that a quarter of these hospital stays are covered by private insurance, which often has high co-payments, and 10% were “self-pay / free” where patients are often billed but unable to pay.
The maintenance costs are never discussed
I am a psychiatrist in New York City and have cared for hundreds of patients who have been involuntarily hospitalized. Costs are almost never discussed. Many patients with severe mental illness, unlike Britney Spears, have low incomes. In an informal poll of my colleagues on the subject, the most common answer was: “Yes, this feels wrong, but what else can we do?” If patients pose an acutely high risk to themselves or others, psychiatrists are obliged to admit them to hospital even against their will and even if this could lead to long-term financial burdens for the patients or their families.
While hospitals sometimes cover the cost, patients can be left with ruined credit, endless collection calls, and added distrust of the mental health system. In cases where a hospital wants to sue, patients can even be detained if they fail to appear in court. On the hospital side, unpaid bills could also encourage a hospital to close down psychiatric beds in favor of more lucrative medical services with better insurance reimbursement such as outpatient surgeries.
“You took advantage of my desperation”
Rebecca Lewis, a 27-year-old Ohioan, has been grappling with the personal costs of involuntary hospitalization for three years – since she first became a psychiatric patient.
At the age of 24, Lewis began experiencing acoustic hallucinations of people shouting their names, followed by delusional beliefs about mythological creatures. Even though these experiences felt very real to her, she still knew something was wrong.
Lewis didn’t know where to turn and called a crisis line; the person on the phone advised her to go to an evaluation center in Columbus. When she drove there herself, she found an ambulance waiting for her. “They told me to get in the ambulance,” she says, “and they said it would be worse if I walk.”
Lewis, who was eventually diagnosed with schizophrenia, was hospitalized for two days against her will. She refused to sign papers acknowledging responsibility for the charges. The hospital tried to get her mother’s credit card that Lewis had given for emergencies, but she refused to hand it over. She later received a $ 1,700 bill in the mail. She didn’t contact the hospital to negotiate the bill because “I didn’t have the emotional energy to get back to this fight,” she says.
To this day, Lewis receives debt collection calls and letters. When she answers the calls, she explains that she has no intention of paying because the services have been forced on her. Her credit is bad, but she was able to buy a home from a family member; She considers herself lucky considering how difficult it would have been to get a mortgage.
Medical guilt is above their psyche. “It’s no fun knowing that there is something like this out there that I believe I can never fix. I feel like I need to be extra careful – always, forever – because this debt will exist, ”she says.
Today Lewis is receiving outpatient psychiatric treatment that has stabilized her and prevented further hospitalizations, but she still looks back with disdain at her first and only hospital stay. “You took advantage of my desperation,” she says.
Although many thousands of Americans are likely to share Lewis’ experience, we lack reliable data on debt incurred for involuntary psychiatric treatment. According to Dr. Nathaniel Morris, Assistant Professor of Psychiatry at the University of California, San Francisco, we don’t know how often patients are billed for involuntary care or how much they end up paying. Even data on how often people are hospitalized against their will is limited.
Morris is one of the few researchers who has looked into this subject. He became interested when his patients told him that he had been billed after an involuntary hospitalization. He was impressed by the ethical dilemma these bills pose.
“I’ve asked patients how much their treatment will cost and one of the most terrible things is that as a doctor, I often can’t tell them because our medical billing systems are so complex,” he says. “Then when you add the involuntary psychiatric factor, it takes that to another level.”
Overworked patients rarely seek a lawyer
Nor are there any legal regulations on whether or not people who have been admitted to hospital involuntarily should be held accountable for the payment. “I’ve only seen a handful of decisions over the years,” says Ira Burnim, legal director of the Bazelon Center for Mental Health Law. “I don’t know that there is a consensus.”
People who have been involuntarily hospitalized rarely seek a lawyer, Burnim says, but when they do, debt collection agencies will often drop the case rather than face a costly legal battle.
The case of Britney Spears is still making headlines this week, and she could release more details of her conservatory that will highlight the plight of many of the cared for.
Others don’t get this attention. As Rebecca Lewis put it as she reflected on her decision not to contest the bills she faces: “You are Goliath and I am little David.”
Dr. Christopher Magoon is a resident physician in the Department of Psychiatry at Columbia University in New York City.