Abuse in the Mental Health System

Inpatient psychiatric care, once a critical pillar of mental health treatment, is increasingly inaccessible to most.

The Crisis of Short Psychiatric Stays

Inpatient psychiatric care, thought of as a cornerstone of effective mental health treatment, has become increasingly inaccessible due to skyrocketing costs, restrictive insurance policies, and systemic inefficiencies.

After spending two decades as a family caregiver and ten years with a national nonprofit focused on mental health, families, and recovery, one truth has become glaringly clear: the system is failing.

Tangible, credible, and effective help is shockingly scarce. Most care falls on the shoulders of families, and the prevailing advice "let them hit rock bottom and they'll figure it out" is woefully ineffective but still the most recognizable statement in the world of recovery. Rising rates of suicide, mental illness, addiction, accidental overdoses, and incarceration evidence this misguided approach.

At the same time, there’s another troubling side to this broken system: individuals who are detained unnecessarily or inappropriately in mental health facilities under the guise of care. These cases, often overlooked, expose systemic failures that compound the suffering of patients and their families.

Families Fighting for Services: A Losing Battle Against Time

For families, the fight for adequate mental health services often begins long before a loved one reaches adulthood. Parents and caregivers advocate tirelessly for their children, seeking interventions, accommodations, and services in the face of significant barriers.

Many encounter a system that is reactive rather than proactive, punitive rather than supportive, and offers little in the way of sustainable solutions until a situation escalates to a full-blown crisis. Then the advice is to call the police, call 911, take them to the hospital, or call mobile crisis. All triggering and traumatizing when prevention could have made a world of difference.

The challenges intensify when a child turns 18 and is legally recognized as an adult. At this point, families lose access to critical information and decision-making power due to HIPAA regulations, even if the "adult" in question lacks the living skills, insight, or competency to manage their care independently.

The system shifts responsibility to the individual, often leaving families powerless to assist. Any animosity you felt when you were helping a child, intensifies as your child becomes an adult. Both the adolescent and the providers will see you as an enabler, an interloper and definitely part of the problem – despite all these derogatory labels they will still require you to pay the bill.

This transition is particularly devastating for those with severe mental health conditions. The sole reporter and attendee at appointments is now the person struggling with the illness; a dynamic that frequently results in incomplete care, missed appointments, and worsening symptoms. Families, who know their loved ones' histories and needs best, are sidelined, unable to intervene even when they see signs of decline.

The consequences of this systemic flaw are profound. Parents who spent years advocating for their children’s needs often find themselves watching helplessly as their adult children fall through the cracks of a system that prioritizes privacy over practical support. This gap leaves vulnerable individuals without the necessary safety net, further contributing to cycles of crisis and instability.

The Financial Burden of Psychiatric Care

Hospitalization for mental health remains one of the most expensive forms of treatment. On average, an inpatient psychiatric stay costs thousands of dollars. For conditions requiring longer stays, such as eating disorders, the bills are astronomical, $19,400 for a 14-day stay. One of our providers quoted $54,000 per month for their residential program.

I have seen countless families devastated by these costs, ourselves included, forced to choose between our loved one’s health and financial ruin. Spoiler alert, we choose financial ruin every time.

Even with insurance, many face insurmountable bills. Stories like Arline Feilen’s are common, she received a $29,894.50 invoice for a brief stay, with insurance coverage. For many, these financial barriers push them toward outpatient care that is unable to meet a high level of need, leaving people vulnerable to ongoing crises that can escalate to incarceration or repeated hospitalizations.

The Systemic Shift to Shorter Stays

Decades ago, inpatient care often lasted weeks or even months, allowing for proper diagnosis, stabilization, and recovery planning. Today, the average stay is a mere 5-7 days: a shift driven not by medical advancements but by the cost-cutting measures of hospitals and insurance companies. This systemic change leaves little time for the meaningful interventions required to address severe mental illnesses such as schizophrenia, bipolar disorder, CPTSD or major depressive disorder.

In my experience, these shortened stays are stopgap solutions at best. Patients are often discharged without sufficient medication adjustments, coping strategies, or follow-up plans, setting the stage for relapse.

The cycle is predictable: emergency room visits, rehospitalizations, and, tragically, for some, entry into the criminal justice system or death by overdose/self-medication or suicide. How does this serve the patient or the community?

Unnecessary and Inappropriate Detentions

While some patients are denied adequate care, others face the opposite issue: being detained unnecessarily or in inappropriate facilities under mental health laws. Detention under acts like the Mental Health Act (in the UK) and The Mental Health Acts USA (HMSO, 1959, 1983, 2007) are about compulsory detention and compulsory treatment, and the main treatment is medication. Medication alone is known to not be the most effective form of treatment.

For service users, the most controversial form of compulsory treatment is control and restraint and forced medication. Current practices are meant to protect individuals during crises, but the system often falters. Patients may find themselves held in facilities ill-equipped to meet their needs, where treatment is minimal and possibly inappropriate and abusive, and their rights are ignored. You are treated like a piece of meat.

Families frequently report that loved ones are "warehoused" rather than treated, kept in restrictive environments long after stabilization simply because there is no alternative care plan or safe discharge pathway.

Others are detained based on misunderstandings of their condition or bureaucratic inertia, leading to unnecessary trauma. The result is a system that fails to strike a balance, leaving some abandoned without care and others trapped in inappropriate settings.

The Human Cost of Insufficient and Misapplied Care

This dual failure, insufficient care for some and unnecessary detention for others, is devastating. Families are left carrying the burden, with little guidance or support, while patients endure cycles of instability or confinement. For many, this results in deteriorating mental health, strained family relationships, and long-term harm. Families get tired of dealing, compassion fatigue is a real thing.

Jails as the Default Mental Health Provider

The United States incarcerates more individuals with mental health conditions than it hospitalizes. This is not only a moral failure but also a catastrophic misallocation of resources.

Jails are not treatment centers; they are holding pens for individuals failed by the mental health system. Despite decades of advocacy, families like mine still see their loved ones funneled into the criminal justice system due to missed opportunities, and untreated or undertreated mental illnesses.

A System That Borders on Abuse

The prioritization of profit over people in psychiatric care and the misuse of detention powers both constitute systemic abuse. Denying individuals the time and resources needed for recovery, or detaining them inappropriately, worsens their conditions and perpetuates cycles of crisis.

As a society, we have to recognize that these practices dehumanize the very people they are supposed to help.

Unfortunately, the moral brigade prevails, “pull yourself up by the bootstraps”, “I have xyz diagnosis and I am coping”, “what is wrong with you? Get your shit together”, “stop using mental illness as an excuse” and more.

A Path Forward

Reforming mental health care requires more than surface-level changes, it demands a shift in priorities:

1. Hold Facilities Accountable: Mental health and addiction recovery facilities must be put on notice that their current practices are abusive, ineffective, and exploitative.
   
   Given the extreme costs they charge, they should be required to provide clear and consistent data showing measurable improvements for every client that passes through their doors. Facilities must prove that the care they provide is not only efficient but also results in recovery progress that can be maintained.

   Transparency and data-driven accountability should be non-negotiable to justify the exorbitant fees.
   
   Medical Health and Mental Health Care are the only industries in the world where you can fail your clients so drastically they die, but you can STILL demand payment for your services. We would not pay any other company if their model was so ineffective, abusive, and inadequate, yet in health care, it is the norm.

2. Extend Coverage for Inpatient Care: Insurers must be required to cover longer hospital stays for severe conditions as well as pay for step-down programs until that person has recovered enough to return to a life they can live. Cardiac patients, ortho patients, and organ transplant patients, all are afforded time to rehabilitate and recover, not so for mental illness and addiction recovery.

3. Increase Public Health Funding: Expanding Medicaid and state-funded mental health programs can provide a safety net for underserved populations.

4. Provide Housing and Supportive Living: Use the same model as our aging population. Offer those who need it, public housing with supports.

5. Ensure Proper Use of Detention Powers: Safeguards must be strengthened to prevent unnecessary detentions and ensure that all facilities provide appropriate, rights-respecting care.

6. Address Family Exclusion: Laws must be reformed to give families more access to and involvement in their loved one's care, especially when competency is in question. Without forcing them to court to obtain power of attorney. Just listen to someone who knows this person, ask questions, and don’t shut us out.

7. Decriminalize Mental Illness: Community-based care and diversion programs can reduce reliance on jails as default mental health providers. Use these programs to give people a chance to get their lives straightened out. Adding a criminal charge on top of what they are already dealing with simply ensures they will have a harder time reintegrating back into society, and into employment and community relationships.

   Stop newspapers and new stations reporting salaciously and speculating on a person’s mental health with every tragedy. This causes extreme harm to people trying to gain recovery.

8. Educate the Public: Stigma and misinformation must be addressed through widespread awareness campaigns that emphasize the effectiveness of proper care.

9. Integrate Care Models: Combining inpatient and outpatient services can ensure continuity of care and reduce relapse rates.

What Do I Know Anyway?

For twenty years, I’ve witnessed the strain on my family and witnessed through my employment and advocacy efforts in the community the same devastating outcomes for families in our community. The current system that values cost containment over care is detrimental to everyone’s quality of life.

The mental health and recovery system fails individuals on both sides of the spectrum: those denied access to meaningful treatment and those detained unnecessarily in facilities that do more harm than good.

Families are further marginalized, and stripped of their ability to support their loved ones, especially once they reach adulthood.

If we are to break these cycles of crisis, incarceration, and inappropriate confinement, we must demand a system that prioritizes recovery over profit and support over stigma. Only then can we hope to build a future where individuals, and families, receive the care they deserve.