"Unsane" 2018 (Director: Steven Soderbergh) Claire Foy, Jay Pharoah.

Unsane Intake

Unsane, “Refusing to Cooperate”

A button behind the receptionist’s desk controlled the lock to the front door of the facility.

“If someone came in voluntarily, I wasn’t allowed to let them out of the door.”

Lauren Singer, who worked for six months at the front desk of Colorado’s Highlands Behavioral

Patients seeking assessments cannot leave until hospital staff have deemed them safe.

“This may involve restricting their ability to leave the facility.”

Kathleen McCann, head of quality and regulatory affairs, National Association of Psychiatric Health Systems

Lock them in. Bill their insurer. Kick them out. How scores of employees and patients say America’s largest psychiatric chain turns patients into profits.

What The Fuck Just Happened?” Rosalind Adams (2016)

In fact, it’s part of a deliberate pattern of forcibly admitting people in order to make claims on their health insurance. Patients with insurance are admitted on the slimmest of pretenses (any mention of depression or suicidal thoughts in a counseling session will do), and are then tricked into signing the admission paperwork and held at the hospital until their insurance provider stops paying out. That, too, was one of the revelations in Buzzfeed‘s yearlong investigation into United Health Services, America’s largest chain of psychiatric hospitals. Unfortunately, Soderbergh’s grim tale of institutionalized gaslighting has its roots in reality…

The Horrifying True Story Behind Unsane, Hannah Shaw-Williams (2018)

Scores of employees from at least a dozen hospitals said those facilities tried to keep beds filled even at the expense of the safety of their staff or the rights of the patients they were locking up.

What The Fuck Just Happened?” Rosalind Adams (2016)

You’ve been converted to an involuntary commitment.

Records show that her treatment plan listed an estimated stay of five to seven days, in line with the five days her insurance company had approvedShe called her mother to help get her out.  “My daughter has been kidnapped,” she said she told an FBI agent. She called local police. An officer came to investigate, but the hospital refused to produce any paperwork to support her admission. A supervisor told the officer “not to interfere with medical staff,” the police report noted. “Based on officer’s training and experience, officer did not believe complainant was danger to herself or others,” the report stated. It also stated that the officer believed that the hospital was violating her rights. Even the police officer was unable to win her release.

Each year, approximately one and a half million people are taken to psychiatric institutions against their will. That averages out to one person every 75 seconds. Often, there is no reasonable justification for committing a person. According to Bruce Wiseman, psychiatrists commonly make off-the-cuff diagnoses, having no real basis in medical fact, that result in people getting thrown into psychiatric facilities. This is not only possible, but easy to do, as it is sanctioned by state laws. Psychiatrists are given the police power to lock people up against their will.

Laws vary, but individuals are usually locked up for at least three days. During that time, they have no constitutional rights, and no access to an attorney or due process of law. Treatment usually consists of drugs, and sometimes electroconvulsive therapy. After three days, they are then brought before a judge to determine whether or not they’re sane. At this point, chances for release are slim since people are generally not in very good shape after all that has been done to them. Chances for release are far slimmer if the person’s insurance pays for treatment. 

The Hidden Side of Psychiatry by Gary Null, PhD

Unsane is … one of the most authentic depictions of involuntary commitment I’ve ever seen.

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction
Unsane, Phone Call to 911

I’ve never opened up about my experiences being involuntarily committed to anyone outside my immediate family and my very closest friends. These memories are intensely private, painful, and traumatic. … Unsane reveals a kernel of truth about America’s mental healthcare system that’s rarely elucidated as clearly and succinctly: it’s a money-making machine that sees patients as customers to be exploited instead of healed. The entire system is geared to process as many people as possible as cheaply as possible, and this capitalistic greed has a debilitating effect both on patients and healthcare professionals.

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction

My stomach lurched in the scene when she had unknowingly just given the institution probable cause to assume the right of parens patriae wherein the state can take responsibility over an individual to prevent them from harming themselves. It’s similar to what happened to me following an depressive episode where I had broken down weeping in a parking lot one snowy night while bringing groceries home to my university dorm room. I had suffered from intense depression since I was twelve years old as a result of undiagnosed Asperger’s and improperly treated ADHD. I had already suffered one suicidal episode when I was a teenager, so I knew I needed somebody to talk to. When I arrived at the Hospital, I only wanted a doctor I could discuss therapy options with. But what happened next was almost identical to what happened to Sawyer. A nice nurse told her to fill out some paperwork and wait in a waiting room for somebody else to come and speak to her. A second, less nice nurse came out, ushered her through a large reinforced door, and searched her belongings. Then a third, distinctly not nice nurse came and told her to strip down to her underwear so she could be searched. And don’t cause any problems, the third nurse warns. It’ll all be easier if you just do what we say. At no point was Sawyer told she was agreeing to be committed—she was in a panicked frame of mind, as was I the night I went to the hospital.

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction

Current and former employees from at least 10 of America’s largest psychiatric hospital chain, Universal Health Services (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.

What The Fuck Just Happened?” Rosalind Adams (2016)

Nate fills her in on the nature of the Center’s scam—they involuntarily commit as many people as possible under the flimsiest pretenses to milk insurance payments until their coverage dries up. Meanwhile Angela learns from her lawyer that she has no legal discourse as all the paperwork surrounding Sawyer’s admittance were technically valid. Not only that, but Sawyer and Angela both learn that the Center takes every opportunity to prolong commitments as long as possible, particularly over cases of patients “acting out.”

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction

The administrators refuse to believe …, refuse to double-check with the authorities…, and promptly stretch her 24-hour stay to ten days.

At the end of my 24-hour “voluntary commitment” period one of the doctors came to see me in my bed when I was at a particularly low point emotionally. He asked me how I was doing, and in between choked, terrified sobs I said I wanted to go home and threw my pillow against the wall. The doctor sprinted from the room like I had pulled a gun on him. The next morning, I was summoned to his office where he told me that he was oh so sorry, but due to my “outburst” they felt it oh so necessary to keep me committed for at least another week. For observation and my own good, of course. Thinking back, I wonder if he would have been so interested in keeping me for another week if I still wasn’t under my father’s comprehensive health insurance plan.

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction

I wonder if he would have been so interested in keeping me for another week if I still wasn’t under my father’s comprehensive health insurance plan.

Many might balk at the idea of mental institutions deliberately detaining patients longer than necessary. But the reality is that American mental clinics are frequently bastions of corruption. Throughout the past three decades, studies and investigators discovered records of fraud when it comes to narcotic prescriptions and deliberate misdiagnosis in order “to extract every single penny possible” from vulnerable patients suffering from mental illness.

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction

During the battery of electroencephalography (EEG) scans and counseling with which my neurotherapist pinpointed my Autism, he discovered that I was also suffering from PTSD. He asked me if I had recently experienced any traumatic episodes. And I told him the story of my time in the Hospital. I told him everything: of the shit collector; the Oxy addict; the Adderall housewife; the old man with Alzheimers; the smiling doctor who prolong my stay over a thrown pillow; the screaming patients; the withdrawing addicts; the cabin fever; the group counseling; the long boring days; the longer terrifying nights. I told him of how I didn’t know I was agreeing to be locked up, and how I cried and screamed when I realized that I might not ever get out again. My doctor sighed and said he thought we’ve found the cause.

Nathanael Hood, I Lived Part of Unsane: Separating Fact from Fiction

Since psychiatric hospitals are reimbursed for each day that a patient stays, extending patients’ stays can drive up a hospital’s revenues. But billing for treatment that is not medically necessary can constitute fraud. And for patients themselves, who are needlessly held in locked facilities, the experience can be devastating.

FBI & Defense Department Are Investigating America’s Biggest Psychiatric Hospital Chain

When those 72 hours were up, he expected to go home. But the hospital would not release him. Instead, the hospital filed a petition in court to hold him longer. Just filing that petition gave the hospital the legal right to detain him until he had a court hearing. Those petitions are meant to be used only in extreme cases but filing them became standard practice. “The rule of thumb is: If you came in under a Baker Act, we’re going to file a petition, and then we figure out what the days situation is” with the insurance company. “If they didn’t have insurance they were discharged.” But if they did have coverage, filing the petition would allow them to hold the patients in the hospital, and to keep the insurance money coming.

What The Fuck Just Happened?” Rosalind Adams (2016)

“Don’t leave days on the table.”

“If an insurance company gave you so many days, you were expected to keep the patient there that many days,” said Rick Buckelew, who ran Austin Lakes Hospital in Texas until 2014. It was a “common practice” that was openly discussed in regional conferences as well as phone calls with hospital executives.

Every state has its own involuntary commitment law, which allows for patients to be held against their will if they are considered a threat to themselves or others.

What The Fuck Just Happened?” Rosalind Adams (2016)

In 1887, Nellie Bly, a journalist for the New York World undertook to get herself committed to the Women’s Lunatic Asylum in Manhattan. Feigning poverty and insanity, she was quickly admitted, at which point she immediately reverted to her normal habits, always maintaining that she was perfectly sane. The doctors merely interpreted this as a manifestation of Bly’s delusions and refused to believe that they had made a mistake in admitting her. In writing about the event, Bly insisted that the other women with whom she was housed were just as sane as she was.

… in 1972, psychologist David Rosenhan undertook the same experiment, with the same results. In an article published by the prestigious Science journal, Rosenhan described how, in his experiment, eight sane people gained admittance to twelve mental hospitals. The actors visited emergency rooms and confessed to hearing indistinct voices. They were promptly diagnosed with schizophrenia and admitted into psychiatric institutions. As soon as they were admitted, they admitted that there were no voices and proceeded to behave normally. Not one of the actors was detected as a fraud, and they were eventually released with a diagnosis of “schizophrenia in remission.”

Steven Soderbergh’s “Unsane” Exposes the Nightmare of Involuntary Commitment

Insurance fraud seems to be the bread and butter of the mental health industry. Scams occur whenever a psychiatrist or a psychiatric institution bills Medicare, Medicaid, or private insurance companies for work they didn’t do, for unnecessary or bogus treatments, or for patients confined against their will.

The Hidden Side of Psychiatry by Gary Null, PhD

“We were tired of seeing these people, these humans trapped in a system that there really was no escape, this system of [involuntary commitment]. This is far too often the way of treatment … stick these folks in handcuffs, put them in a squad car, and take them to the emergency department.”

Julia Wacker, North Carolina Healthcare Association, Mental Health Policy Analysis

“…Thousands of adolescents, children, and adults have been hospitalized for psychiatric treatment they didn’t need … patients are kept against their will until their health insurance benefits run out … [and] bonuses are paid … for keeping the hospital beds filled.”

— Pat Schroeder, U.S. Congresswoman (1992)

The U.S. Justice Department has been investigating UHS behavioral facilities for more than a decade.

The enterprise works to admit people to facilities, whether they need to be admitted or not. Then, once admitted, the enterprise goes to extraordinary lengths to ensure that a patient is kept as long as a payor will pay or, upon suspicion and belief, until such time as a replacement patient or set of patients can be obtained. In furtherance of this scheme, admission documents are forged; documents to secure that a patient will remain in a facility are falsely notarized and then filed into the state court system; and, in some cases, a person’s medical record is written to reflect that services were provided or that certain events occurred, when, in fact, they did not occur.” 

UHS and its affiliates will enter in clandestine joint ventures with physicians, predicated upon increasing referrals, increasing admissions and increasing lengths of stay.”

Civil Action No. 4:18-cv-00615-ALM

In the last decade, UHS and its affiliates have been sued by both the federal government and by dozens of state governments for insurance and health care fraud. Sixteen psychiatric facilities closed in the U.S. in 2018 amid investigations and allegations of patient abuse.

Fraudulently hospitalized citizens have been held until their mental health insurance benefits ran out. … The psychiatric “diagnosis” was often changed to exhaust the insurance coverage. Mark Schiller, president of the American Association of Physicians and Surgeons, admitted, “I have frequently seen psychiatrists diagnose patients with a range of psychiatric diagnoses that aren’t justified, to obtain [insurance] reimbursements.”

Massive Fraud Psychiatry’s Corrupt Industry

Once people are committed, it goes on their insurance record. These people…are appalled that they now have a psychiatric record for the rest of their lives.

Randy Lakel, Feb. 17, 1995

“For adults, disorders that are fraudulently billed for include Caffeine Intoxication/Withdrawal.”

Massive Fraud Psychiatry’s Corrupt Industry

In the third quarter of 2018, UHS said it added $48 million to its reserve for an ongoing investigation into its behavioral health facilities by the Department of Justice. The reserve now totals about $90 million.

“Changes in the reserve may be required in future periods as discussions with the Department of Justice continue and additional information becomes available,” UHS said in an earnings release.

“UHS sees jump in net income, ups reserve for DOJ investigations to $90M,” Becker’s Hospital Review, 25 Oct. 2018, 
https://www.beckershospitalreview.com/finance/uhs-sees-jump-in-net-income-ups-reserve-for-doj-investigations-to-90m.html

“Paying for Fraud/A special report.; Mental Hospital Chains Accused of Much Cheating on Insurance,” New York Times, 24 Nov. 1991, https://www.nytimes.com/1991/11/24/us/paying-for-fraud-special-report-mental-hospital-chains-accused-much-cheating.html

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