Last week, a New York Times investigation revealed a pattern of unsettling practices by one of America’s largest chains of psychiatric hospitals.
The chain, Acadia Healthcare, had drawn patients to its facilities and held them against their will, even when it was not medically necessary, The Times investigation found. Unless lawyers intervened, Acadia often held these patients — some for nearly a week — until their insurance ran out, maximizing payouts for the hospital.
After receiving a tip last year, Katie Thomas and Jessica Silver-Greenberg, Times reporters who have collaborated on several investigations, began looking into Acadia. This year they reached out to dozens of patients and their families, as well as current and former Acadia executives. For months, they pored over court files, police reports, complaints to state authorities and health inspections to learn what was taking place.
When asked for comment, an Acadia spokesman said the patient examples cited by The Times were not representative of many patients with positive experiences, adding that “quality care and medical necessity drives every patient-related decision at Acadia.”
In an interview, the journalists discussed how they approach reporting as a team, the challenges of a monthslong investigation and what the article means for the health care system in general. These are edited excerpts.
How did you find out about this situation, and what made you decide to pursue an investigation?
KATIE THOMAS While we were reporting last year on unnecessary medical procedures, someone told us: You should take a look at this company, Acadia Healthcare. They have had a lot of issues with quality.
We both felt it was a good moment to look at a mental health company because of the surge in depression and anxiety rates coming out of the pandemic. We requested documents through open records laws in every state where Acadia operated inpatient psychiatric hospitals. We asked for state inspection records and complaints to either state health officials or to state attorneys general.
When we started talking to people, it emerged that some patients were being held involuntarily, and not for medical reasons.
You’ve worked on several investigations together. How does your reporting process work?
JESSICA SILVER-GREENBERG We have a nice rhythm. When we first learn the landscape of a subject and call experts, we make those calls together so that we’re not duplicating work and so nothing is lost in translation.
Acadia operates 54 inpatient hospitals in 19 states. It’s a pretty large landscape. We tried to go broader with this investigation and establish how widespread this pattern was; with a lot of health care investigations, you don’t want a story to be dismissed as one bad hospital or one bad doctor. We divided the states and put together this massive spreadsheet of current and former Acadia executives, staff and psychiatrists.
THOMAS We had a list of 242 potential people, and we reached out to pretty much all of them.
What was the most challenging aspect of this investigation?
SILVER-GREENBERG Getting employees to speak on the record, because they’re all still very much working in the health care space. By speaking out, it does foreclose some job opportunities. I was very moved by their willingness to speak out because they thought it was imperative to expose these practices.
We only included the stories of people who had independent corroboration to buttress their experiences. We wanted to do it as powerfully as possible and to have credibility with readers.
THOMAS For the patients, too, because there are stigmas with mental health. We also felt it was important to have named patients, though not everyone was.
Having done so many investigations, is there a familiar feeling before you publish?
THOMAS There’s always anxiety that somehow we overlooked something. We check and recheck, and then there’s something that jerks you awake at night.
SILVER-GREENBERG There’s also a great feeling: when you start recognizing you have a story. When every single person you’re speaking to brings up the same thing, unprompted — when you look down at your notes and think, “This person from Georgia and a different person who doesn’t know them are saying the same thing” — that gives you real confidence in the scope of the reporting and the accuracy of it.
Did this article alter your view of the U.S. health care system?
SILVER-GREENBERG I have been stunned by the number of people who wrote us saying, “This same thing happened to me.” Katie and I have been reporting together and separately for decades. And I would say this story, more than any other story I’ve reported, has generated the most response from readers.
Many employees said that they suspected these practices would be exposed, and dozens of patients and their families wrote to us to share similar experiences. We’ve gotten so many emails from people that said, “I was waiting for the other shoe to drop.”
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