Customer Reviews

Bedlam: Greed, Profiteering, and Fraud in a Mental Health System Gone Crazy

5 star:		(4)
4 star:		(1)
3 star:		(1)
2 star:		(1)
1 star:		(0)

 

 

This is a truly shocking book. In terms of content, it could be said that there is nothing new under the sun: the psychotherapy industry is greedy and corrupt. Plenty of writers from Masson onwards, have revealed to us the real motivating factors for many mental health professionals: greed and narcissism. But even the harshest cynic will be horrified by the details contained in this work. Thoroughly researched and beautifully written. Excellent.

Reviewer Charles Hannasch is correct in his observation about the swift publication of Sharkey's book. I am not aware that other books or publications of this story were hurt thereby. However I wish that Sharkey had interviewed me about some details since I'm the one who initially trained Sector One personnel on mental health emergency detention warrants and because of that involvement assisted (then State Senator) Frank Tejeda's office in the investigation.

In my own book, Enhancing Police Response to Persons in Mental Health Crisis, Charles C. Thomas, Publisher, 2003, I give some additional detail about the background of Sector One and the alleged kidnappers and ability in those days of civilians to execute mental health emergency detention warrants.

If he were to write a sequel or second edition Sharkey might note that quite rightly (at least in my view) all charges against the so-called "bad guys" were ultimately reduced to misdemeanor status.

Mr. Sharkey's account is well-told; his word-smithing skills unparalleled.

Joe Sharkey's view of the truth behind the medical insurance field is rivoting. I am proud to know this man

Arrived promptly and was in the same condition as it was decribed to be. Hard to find book. Glad I found it here.

With a minimal of original research, Sharkey relies extensively and primarily upon one of the biggest newspaper investigative projects in U.S. history, and gives it only a minimal acknowledgment. Dubbed "Profitable Addictions" and published in the Houston Chronicle, the investigative series comprised some 110 major stories over a two-year period and was nominated for a Pulitzer Prize. Sharkey, the son-in-law of a psychiatrist who probably felt some pressure from the powerful for-profit psychiatric hospital chains, pens a near "apologia" for the industry, rather than laying out the full fascinating story as laid out by the Huston Chronicle, which impacted for-profit hospital regulation as far away as Australia, and resulted in the creation of a permanent healthcare fraud section within the FBI and a record (for the date) settlement of $375 million settlement for healthcare fraud..still the second highest fraud settlement in U.S. history. Unfortunately, the swift publication of Sharkey's book hurt the publication of other more thorough and less sappy books than Sharkey's, and thus did an actual disservice to menatal health and patient care and the reading public in telling a most fascinating yarn of pure corporate greed.

The focus of this book is on how corporate, for profit, mental hospitals put aside all ethical concerns and took advantage of distressed people that sought mental health, addiction treatment, or crisis counseling. As the author described it:

"These hospitals devised vast promotional programs -- aggressive advertising coupled with painstaking media manipulation and systematic kickbacks to counselors and others who might have access to troubled potential patients -- to create a whole new product niche: treatment in psychiatric wards for people who had never before been regarded as candidates for inpatient psychiatric care." (p. 11)

Much of the book is anecdotal. The accounts of various people that came into contact with corporate mental health hospitals is shocking. The reoccurring theme was that marketing was used to seek out as many people as possible and finder's fees were paid to those that referred people to the hospital. Then the hospitals would keep people in "treatment" for as long as their insurance would cover the expenses, even switching their diagnosis to extend their stay. Once the insurance money ran out, the patients were pronounced "cured." Occasionally, bounty hunters were used to "escort" people that were reported to be in need of mental health services, but only those with good insurance, of course.

One of the most important lessons this book provides is just how wrong the mental health system can get. This book serves as a reminder that even recently, psychiatrists can throw all ethical concerns out the window for money. Sadly, only treating those that had insurance coverage was a concern, and not those with genuine problems.

Bedlam is a detailed and at times excellent expose of the perverse way in which our mental health system grew in the decades leading up to the 21st century. Journalist Sharkey exposes the use of forcible detention, incarceration, kidnapping, the deliberate falsification of diagnostic procedures, the abuse-such as with the inappropriate use of restraints and medications-of mentally ill or vulnerable patients, and the subsequent attempts by the industry to cover their tracks and escape punishment for their fraudulent and felonious activities. Numerous stories, both horrific and comical, such as one instance where a perfectly normal patient, in order to escape institutional incarceration, got married but didn't 'consumate the marriage', are related.

But why then only three stars? Well, there's a significant problem with the book: Sharkey, not being an economist, by and large misdiagnoses the causes for these crimes, attributing them to free-market forces, de-regulation, and 'the profit motive'. But as recent events in 2008 and 2009 with the housing crisis show, booms in one area of the economy are often caused by government subsidies and funding, either directly, as in housing by Fannie Mae and Freddie Mac and their subsidies of low-interest mortgages, or indirectly, by the Federal Reserve pumping up the economy with it's low interest rates, with huge amounts of this increased money supply subsequently flowing to the housing sector. The same process, incidentally, is happening in education, with government subsidies and grants having caused in the last twenty years huge increases in college tuitions. (What often also occurs with this gargantuan, governmental funneling of money is increased corruption within that sector of the economy.) Sharkey unfortunately, by and large, although he at times mentions in passing vital causes such as increased Medicare funding, misses the correspoding process at work here.

A typical example, with a question which Sharkey asks near the end is why the insurance companies, who were paying all these enormous bills, didn't investigate what was going on. And the real answer which Sharkey doesn't give us? Payment of these claims was often legislated and mandated by state and federal governments, who thus forced deep-pocketed companies to pick up the tab. (At one point Sharkey mentions that these claims totaled "24 percent of corporate America's pre-tax profits," and he also mentions at times the additional problem of third-party payments, with their resulting cost-cutting disincentives for consumers, but he never integrates these points into a coherent and consistent economic rationale.) Why, then, would insurers have objected to paying these claims when the system was rigged and their profits ensured by law through the passing on of these costs to the patient's employers? Here 'the profit motive' was actually undermined by the government, who, by guaranteeing profits, removed the motivation of insurance company investigators to discover the fraud earlier.

Good arguments detailing in depth how far from a free-market the general health care system really is, where the reader will find a necessary corrective to Sharkey's misunderstanding of the pernicious and comprehensive role government played in unwittingly promoting this catastrophe, can be found for example in The Cure: How Capitalism Can Save American Health Care, or the Cato Institute's Healthy Competition. You think a system where children and adults are kidnapped, abused, and held as prisoners, where the government through its hugely debt-funded ($45,000,000,000,000 unfunded obligations in 2004) Medicare program subsidizes and pumps federal money into the mental and general health care industry, and where the government mandates that companies pay for the resulting enormously expensive and bogus therapy is a free-market? Think again.