I’m a reporter who investigated a Florida psychiatric hospital that earns millions by trapping patients against their will. Ask me anything.

How did you first find out about this facility? Do you think anything will be done regarding the facility as a result of your reporting?

This all started with a tip from a family. A woman called and said her 80-year-old mother was trapped inside. She was struggling to see her or even speak to a doctor. She said, during one of the few allowed visiting hours, she met other families with almost identical experiences. I started calling around and heard the same thing again and again.

It's too soon to tell what will happen, but I'll be reporting and keeping an eye out.

Are you digging into other facilities owned by Acadia? Seems like that is the root of the problem.

And I was surprised to see Acadia Healthcare is publicly owned, so one effective way to pressure them is to encourage their large shareholders to divest.

Acadia Healthcare Company, Inc. (NASDAQ:ACHC) has 275 institutional investors and shareholders that have filed 13D/G or 13F forms with the Securities Exchange Commission (SEC). These institutions hold a total of 114,093,418 shares. Largest shareholders include Price T Rowe Associates Inc /md/, Wellington Management Group LLP, Vanguard Group Inc, BlackRock Inc., Aristotle Capital Management, LLC, P2 Capital Partners, LLC, Dimensional Fund Advisors Lp, JP Morgan Chase & Co, Elliott Management Corporation, and Ares Management Llc.

T Rowe Price recently increased their stake to owning 14.8% of the company, and Wellington Management Group increased to 11.4% ownership. Vanguard appears to have their holdings split between entities but together own almost 15%.

If you have any relationship (retirement accounts) with those organizations, you could contact them, divest yourself and explain that you encourage them to divest themselves.

I am looking into all of this. Like I say in the post: Our reporting on North Tampa Behavioral and Acadia is continuing. If you know anything, email me at [[email protected]](mailto:[email protected]).

I used to work for Acadia, was not surprised this was one of their facilities by the title. Although I figured it would’ve been about Park Royal in Fort Myers.

Would love to talk to you if you're interested. Send me an email: [[email protected]](mailto:[email protected]). Thanks.

I was a third party patient biller for acadia and did work on a lot of the billing for their facilities- saw SO much corruption. All they cared about was money. My favorite was their policy on sending patients to collections after billing once or not at all. So glad they are being exposed.

Would really like to hear more. Send me an email: [[email protected]](mailto:[email protected]). Thanks!

Is any legal action being taken to stop this and hold the hospital accountable? This sounds like a dystopian novel come to life

Some of these patients would occasionally hire lawyers to help get them out. The presence of a lawyer sometimes made things smoother (but not always). I haven't seen any larger legal action take place.

I work in healthcare and see the Baker Act misapplied pretty routinely. Sometimes even to just prevent a patient from leaving AMA when they pose no threat to themselves or others. Do you think it's time to revisit and reform the Baker Act?

I've thought about this before, but I don't think there is any political will for changing the law. It affects so few people and there is all this paranoia around preventing mass shootings.

I'm not sure, tbh. Experts say the law itself is pretty strict about insuring patients are guaranteed certain rights and aren't exploited. But there is a trend of facilities following incorrect interpretations of the law. There was an editorial in our paper from our editorial board responding to this: https://www.tampabay.com/opinion/2019/09/27/the-baker-act-is-supposed-to-protect-patients-not-profits-editorial/

Do you have any recommendations for people to stay safe based on anything you have learned? For example, If a person felt wary of something like this going on near them, but still needed mental health help, are they just screwed?

No, they should definitely seek help. We did identify problems here but the system as a whole is important, and people who need mental health help should seek it. I think a little bit of research ahead of time could help. The online reviews from this facility had already echoed some of the issues we found. Also there are generally public records about state inspections online. (You can look up most healthcare facilities in Florida here: https://floridahealthfinder.gov/)

Last year, it hired its fifth CEO in five years. Bryon “BJ” Coleman was a quarterback on the Green Bay Packers’ practice squad in 2012 and 2013, played indoor and Canadian football, was vice president of sales for a trucking company and consulted on employee benefits. He has no experience in healthcare. Now he runs the 126-bed hospital.

Why would they hire someone like this, with literally zero medical experience, to run a medical facility? I looked up Acadia Healthcare and saw that their current CEO has only been there for less than a year. The whole corporation is crazy sketchy.

I don't think I have an answer to this question. But the story does have his response to this:

In his statement to the Times, Coleman said he had experience in logistics, financial forecasting and customer service, as well as “valuable, transferable skills and attributes including team leadership, situational analysis and sound decision-making.”

Full statements are also online: https://www.tampabay.com/investigations/2019/09/18/read-north-tampa-behavioral-healths-response-to-our-investigation/

Wow, a journalist that investigates real issues?

That's a nice change from the trend. Thank you.

What do you think of the current state of journalism in the US & the UK?

Wow. That's a big question. I don't really know. I think it's a hard time for journalism, the industry has been hurting financially for a while and local papers have been taking the worst of it. But some of the best journalism is still being done at those papers and that keeps me going.

I remember this being the plot to one of the seasons of American Horror story, basically a reporter checks herself in to go deep undercover, and then finds herself being held their against her will, with the idea that only a mentally ill person would claim that she's healthy, and finding ways of making her normal actions seem crazy.

If you were admitted into their system, how could you be sure that you can walk back out again, if you were to go deep undercover?

That season was great. I don't have any good ideas (we also don't do undercover reporting here, per policy) and I'd probably do pretty badly if I was a character on that show.

Are most mental patients being held against their will?

In this facility, yes. Most of the patients are brought in under the state's mental health law, the Baker Act. Roughly two thirds of the total patients are brought in involuntarily.

EDIT: I AM SORRY I STRUGGLED WITH REDDIT. I would have edited sooner but kept getting "Something went wrong. Just don't panic."

(not sure where that "save" came from...)

Do you suspect this kind of thing is widespread in the industry? Or is this an aberration?

I haven't done the reporting to know for sure. But I will say that after the article published, I started getting calls from patients across the state saying the same thing happened to them. I don't know if I've ever heard from this many readers before after a story published.

Hi, I am a psychiatric nurse in CA who has worked for facilities that illegally extend holds to fill beds and collect Medi-Cal money. The poorer and less able you are to advocate for yourself the longer you would stay. I sent you a private message with proof and details but please help me go to the press with my story!

Hi /u/yahutee! I will respond to you by the end of the day (if I don't, please bug me or email me at [email protected])

Hey Neil,

First off, I wanted to thank you for standing up for psych patients, because not enough people will.

Are you familiar with the Troubled Teen Industry? It sounds really similar to what you've been looking into. Often, "consultants" for the clinics will give false or exaggerated diagnoses and refer kids to programs they receive a kickback from. The kids are bounced around different clinics until the parents run out of money, or catch onto the scam.

It's a HUGE industry in the US, and incredibly damaging to the patients.

I was stuck in the troubled teen industry as a patient for two years, and years later I still struggle with PTSD from being put in solitary, kicked, slapped, and forced to skip meals as punishment.

Thanks for your time and the work that you do.

I haven't heard about this but I'll definitely read more. Will put it on my reading list. Thank you for your kind words.

If one found themselves trapped against their will, what is the best advice you have for them?

This is a good question, and a difficult question. The law does allow hospitals to hold people who may harm themselves or others. But it also outlines many rights for those patients. I think my best advice is for patients to know their rights and know the state organizations you can contact if you feel like those rights are being violated.

What do you hope comes from your article?

My main hope is that more people read it and are aware of the issues we outlined. Almost all of the families I spoke to said they were completely unaware of any problems when they ended up at the hospital. In fact, their first thought was generally how nice it looked from the outside.

I worked at a children's psychiatric hospital in Pittsburgh run by Acadia (Southwood Psychiatric Hospital). You aren't exaggerating how bad Acadia is, in fact it's almost impossible to understand the full extent of it without first hand experience. How did you manage to get the records without massive HIPAA violations? I would have loved to have helped you out when I was working for them (2014-2017)

Edit: bad mobile grammar

Thank you for reaching out. I'd love to chat if you're interested. Shoot me an email at [[email protected]](mailto:[email protected]).

The patient records came from the patients which makes it no longer a HIPAA violation. The court data was retrieved with a public information request to the clerk of court.

"To forcibly hold a Baker Act patient for more than three days, a mental health center must file a petition in court. Under the law, a judge has five work days to rule on the case.

North Tampa Behavioral filed 592 such petitions last year. But it dropped 86 percent of them before the hearing, records show. Hundreds of patients were stuck waiting to see a judge, but never saw one. Meanwhile, their bills grew."

As someone who works at a mental healthcare facility, I found this to be horrifying. Do you mean the patients in the 86% thought they needed to wait to see a judge when in actuality their petition had been dropped? Or just the remaining 14%?

Also, did you find that the 14% for which a petition for extension remained were being held for legitimate reasons? While the incidents you documented in your article certainly do not seem to meet criteria for extension (no threat to self or others, not incompetent, etc), there are certainly patients who do pose a major risk or are seriously ill and cannot make rational decisions - they need to stay in a facility. Was this the case for any in the 14%?

86% of these people were waiting for hearing but the hearing never happened. I do agree that some patients definitely do meet criteria. I had no way of telling how many though. The county court always grants these petitions when they go to hearing. And the petitions themselves are not public record so I couldn't personally see them.

I am very interested. Have you spoken to anyone from the hospital, specifically the psychiatrists who are in charge of determining when patients get released?

I am a physician who works in this general region of the state. I am not affiliated with facility and don’t have any personal interest in this case. That said, I deal with mental health patients frequently, and it is a very difficult situation. On one hand you want to uphold the patients rights. On the other hand you don’t want to release them in an unsafe condition, which is an incredibly hard thing to determine. I see suicidal patients almost daily, who were just released from a psych facility - clearly they weren’t ready to leave. With Baker Acts, someone is almost always telling you are wrong, wrong for keeping the patient, wrong for discharging them. Basically all you can do is try your best to do what is right for the patient and accept someone is always going to be upset. Dealing with BA52s is one of the least favorite parts of my job.

With medical billing, as a physician I am generally incentivized to provide efficient care. Keeping patients longer than needed would rarely increases my profit margin. Additionally, most of us are independent contractors- we work at the hospital, but not directly for the hospital. So while a hospital might want to be able to bill for longer stays, the physician is the one determining who goes home and when. Mental health patients will almost always tell you they don’t need to be admitted - lack of insight is often a hallmark of their diagnosis. Family members are frequently kept in limited contact because they often enable patients, bring them drugs/alcohol (I see this EVERY day)... etc.

I have worked for a number of for-profit centers and they mostly suck. They understaff and find other ways to cut costs. Safety isn’t always a priority. They might not always follow through on regulations. That said, the physicians are still always in charge of patient care.

How have you determined that their cost cutting mechanisms and poor regulatory efforts are directly related to maliciously keeping patients longer than necessary? I am not defending the facility (which seems to have definite issues) but a lot of these types of stories are sensationalized and one sided. I could list countless patients/families who would say admission wasn’t necessary, yet the patient in general was a very clear danger to themself or society, yet it would be easy for a reporter to interview them and spin a story that pulls at heartstrings of readers, and turns them against the big bad corporation. In this case I am not disputing your claims against the corporation, but do question the link to the psychiatrists who determine length of stay, as in my experience, that’s not necessarily how it works. Hell, there is such a lack of mental health beds in the area, most facilities seem to be trying quickly discharge existing patients to make room for new the new ones.

I am sorry if this all seems kind of blunt, but I have been in the industry for over a decade and it still confuses me. You seem to have written a very one sided and superficial investigation into an industry, yet might not fully understand the extreme difficulty that comes with determining a mental health patient is safe for discharge. Again, I am not saying this facility isn’t culpable, but also aren’t entirely sure about all your claims.

Thanks for your question. I answer an identical one above. I'd also say that former employees reached out when the article published and confirmed all of the findings.

What makes this unique from any other privately run psychiatric facility? Or prison?

I don't know if I'm answering your question but we did find that the hospital stands out from others for its high profit margins AND its many cited problems. https://projects.tampabay.com/projects/2019/investigations/north-tampa-behavioral-health/#chartbuilder-export

How do they proceed to keep patients against their will? Can't their relatives do anything about it to contest?

Going to copy my answer above because someone asked a similar question:

The law is interesting here. The Baker Act is intended to protect people who are a threat to themselves or others due to mental illness. It allows a hospital to restrict a person's rights in these situations. But it also has strict guidelines so the patients are still protected. The article outlines how the hospital skirts or breaks those guidelines. It's also why even though some families fought hard against this, they felt like they couldn't do much.

What is the average stay of a patient at this facility vs the average?

In 2017 (the most recent year of comparable data available from the state), the average length of stay at the hospital was 8.8. The other psych facilities in the county that take Baker Act patients from the same location had an average of 5.1 days. If you compare to facilities that take at least 50% Baker Act patients, it had the second highest average length of stay in the state.

I just want to say the work you’re doing is really important and I hope every person in your life tells you that every day. I hope you hear it from your parents and your spouse and your bosses and coworkers and from strangers on the street.

Even “well run” involuntary commitment hospitals tend to lead to more suicides and worse health outcomes and are for most “patients” (really inmates) a form of torture, which is why involuntary commitment for all but the absolute most extreme cases is discouraged in more progressive parts of the western world.

It is terrifying to imagine what an intentionally manipulative and badly run place would be like.

—

As for a question:

in your reporting have you done much historical reading going back to draw parallels to 50, 100, and 200 years ago (etc) when men would routinely have their wives and daughters locked away in sanatoriums?

A lot of those sanitariums were also privately run and quite profitable.

Thank you very much for your kind words. Unfortunately I don't have a good answer to your question because I haven't done a historical look.

What kind of legal recourse do people have against this kind of behavior? Shouldn't there be a state or federal investigation going on? Systematic false imprisonment seems like the kind of racket that should lead to hefty prisontimes for those responsible.

Good question. There are rights outlined in the law that you are guaranteed and there are lawyers who specialize in the rights of mental health patients. A few of the families I spoke to did end up hiring lawyers to help get their loved ones out.

Which loopholes in the law would allow this sort of a thing to happen?

Thanks for the question. We outline this in the story: https://projects.tampabay.com/projects/2019/investigations/north-tampa-behavioral-health/

One of the largest ones is the petition process. That stats we found are striking.

What was the most difficult part of this investigation for you? (Edit: I meant difficult as in mentally-taxing, but you could also answer which piece of evidence was the hardest to obtain)

This may have been one of the toughest times I've had getting patients on the record. I think there's still a ton of stigma around mental health and most people did not want their names and experiences published.

I'm wondering how the victims can ever recover here. If they were already struggling with mental illness, now there's surely PTSD on top of it and any sort of mental health treatment center or doctor will be a trigger...have you followed what happened to people after?

Some of the patients I spoke to did deal with trauma after their stays. I'm glad to say that many are better after seeking care afterward.

It’s clear that investigative reporting is crucial for a healthy, functioning society, but it seems like the landscape of modern publishing (hard and soft) doesn’t make room for it.

What can I do to support these kinds of endeavors? Buy my local paper, I assume? If one still exists. :(

SUBSCRIBE. Readers need to support local papers to support this kind of work (it is expensive). You can subscribe to our digital paper: https://subscribe.tampabay.com/.

I feel like I've seen some solid investigative journalism.out of Tampa Bay. Why is that? Are you guys somehow special among small city papers?

I don't know but we do invest and value this kind of journalism. Here are a couple of columns from our executive editor:

https://www.tampabay.com/news/2019/09/12/tampa-bay-times-journalism-makes-a-profound-difference-in-our-community/

https://www.tampabay.com/news/column-times-investigative-team-exposes-big-problems-at-the-heart-institute-inside-johns-hopkins-all-childrens-hospital-20181121/

If the research and evidence are solid, I currently have no reason to doubt it, how do facilities like this legally stay in business? Also what can be done by the families of these patients to help in the process. It would seem that holding one against their will is along the same lines as kidnapping.

The law is interesting here. The Baker Act is intended to protect people who are a threat to themselves or others due to mental illness. It allows a hospital to restrict a person's rights in these situations. But it also has strict guidelines so the patients are still protected. The article outlines how the hospital skirts or breaks those guidelines. It's also why even though some families fought hard against this, they felt like they couldn't do much.

Do you see any difference on the holds on a patient voluntarily committing themselves then classified as a baker act (ie someone who walks in saying I want to kill myself) and one involuntarily (attempted self harm and was placed there by emergency services)?

From the patients I spoke to, the experiences were pretty similar. Many of the ones that were held involuntarily also knew they needed help and were looking for help. And patients who came to the hospital voluntarily said they had no idea they could request to leave.

Is there any type of government oversight to protect the patients? Given the circumstances, the patients and their loved ones seem completely at the mercy of the facility. Also, are people being placed in these facilities by the state without the patient or their family being given options?

Patients and families don't get to choose the facility they go to. It's up to the law enforcement officer or medical professional Baker Acting them. There is some government oversight, a couple of state agencies do inspect these organizations. There used to be a group that visited these facilities and spoke to patients but that group got defunded a few years ago.

You said the hospital cuts patients off from their families. What led you to make this statement?

The law guarantees "immediate access" between families and patients. It also guarantees that patients should be free to make private phone calls. But the hospital restricted visitation to two one-hour blocks every week. The top experts in the state's mental health law called those hours "overly restrictive" and "totally inappropriate."

Related: https://www.chicagotribune.com/news/ct-uhs-probe-hartgrove--20150401-story.html?outputType=amp

Also related:

https://mtstandard.com/news/local/acadia-montana-use-of-injected-medication-tolerated-for-years-in/article_d94f659c-d479-5a6d-979a-305c2d1b9bdf.html

https://projects.seattletimes.com/2019/public-crisis-private-toll-part2/

You had mentioned that the many media outlets are having trouble staying profitable. Do you believe that this is affecting the ability of the media to maintain a balanced perspective?

No, the journalists I know all maintain extremely fair and unbiased perspectives.

Can you please find a way to report your story to Charlemagne The God from The Breakfast Club so he can give Florida another Donkey of the Day?

Ha. I have no idea how to do that....