Acadia Healthcare Investigated for Misconduct at its Psychiatric Hospitals

A recent New York Times investigation has uncovered possible misconduct occurring at the psychiatric hospital chain, Acadia Healthcare, involving trapping patients against their will and for no medical purpose. In an effort to maximize profits at all costs and prolong patient stays, Acadia is accused of exploiting involuntary commitment laws by misrepresenting whether a patient is a danger to themselves or others. Now, as more and more allegations surface, including patient abuse, Acadia is starting to feel the repercussions of these accusations, as their stock price fell over 4% after the release of the Times article.

Who is Acadia?

Acadia Healthcare is one of the country’s largest chains of psychiatric hospitals and behavioral healthcare services, with 253 locations and 54 inpatient hospitals nationwide. The chain offers inpatient and residential options for adolescents and adults who are experiencing psychiatric symptoms and are in need of behavioral healthcare services. Per their website, the goal of the “intensive, short-term” inpatient stay is to “achieve stabilization” so that the patient can return home or transition to a lower level of care. The typical length of stay is said to be five to seven days. Residential care can range from a few weeks to several months. Acadia also offers a detoxification program from drug and alcohol users, with the length of stay between three to five days.

Acadia is an example of the recent shift that psychiatric services have experienced in the last decade. As facilities run by government or nonprofit groups have closed their doors or cut back services, Acadia and other for-profit companies have filled a void in psychiatric care. These companies have also benefitted from the Affordable Care Act mandate that insurers cover mental health treatment, as the majority of Acadia’s revenue comes from government insurance programs. Likewise, the COVID-19 pandemic and its effects on mental health and substance abuse also led to an increase in Acadia patients. As a result, Acadia has enjoyed record profits and a stock price that more than doubled since the pandemic. It is valued at $7 billion and its chief executive, Christopher H. Hunter, earned over $7 million last year.

Wrongfully Detaining Patients

The law enables medical facilities to involuntarily hold a patient for a certain amount of days – usually five – if a patient poses an imminent threat to themselves or others. According to records reviewed by the Times, in at least 12 of the 19 states where Acadia’s hospitals operate, authorities have received complaints from patients, employees, and police officers that the hospitals were detaining patients without a medical reason to do so and in violation of the law. The investigation exposed numerous examples of this practice, which the reporters state were all corroborated before publishing. In one case, a Florida patient spent six days in an Acadia hospital in Florida after she visited a facility to adjust her bipolar medication. In another case, an Indiana woman was held for seven days when she visited a facility seeking therapy, according to a complaint filed with the state’s attorney general. The woman, who was a hospital worker herself, was released only after her father petitioned the court for assistance.

Some patients were simply seeking routine medical care at emergency rooms, but then found themselves in an Acadia inpatient facility, likely because of the “assessors” Acadia would send to local emergency rooms in an effort to recruit patients. A large part of Acadia’s business strategy was to cultivate relationships with emergency room staff and medical professionals, offering to take difficult patients or to help alleviate the ER’s crowded waiting rooms. Although assessors are supposed to be objective, there was a culture of “consistent pressure to send patients to Acadia facilities” as one former assessor describes.

The patient claims have been corroborated by the 50 executives and employees who chose to speak out against Acadia’s motive to detain patients for financial, rather than medical, reasons. Acadia, who charges insurance $2,200 per day for a patient stay, would misrepresent a patient’s symptoms in order to prolong their stay, such as claiming the patients were not well enough to be discharged because they did not finish a meal. Acadia staff was trained to use certain buzz words such as “combative,” in patient charts to support the assertion that the patient should be held. As one psychiatric nurse, Lexie Reid, describes, “We were keeping people who didn’t need to be there.” Acadia would hold the patient at a facility until insurance stopped covering their stay. “If there were insurance days left, that patient was going to be held,” one top Acadia executive explains.

In light of the involuntary commitment laws that permit healthcare facilities to detain patients in certain circumstances, many patients were unable to leave without involving lawyers and petitioning the court. Acadia also petitioned the court for its own benefit, such as the North Tampa Behavioral Health Hospital location that filed over 4,500 petitions with the court to extend patients’ involuntary stays. Although the court granted only 54 of these petitions, Acadia was still able to detain the patient – and bill their insurance – for the days pending the court decision.

Abuse and Neglect

Aside from the wrongful commitment of patients, there have been other abuse and neglect claims against Acadia facilities. According to health inspectors, some patients did not receive therapy or were not evaluated by a psychiatrist prior to being placed on the involuntary hold. Some patients were left unsupervised or denied necessary medications, and the living conditions of the facilities were described as filthy. Other incidents in health inspection reports include rape and assault.

In an Atlanta facility, Lakeview Behavioral Health, police opened an investigation after numerous reported incidents, including a child who visited an emergency room after his Lakeview stay with bruising. The police also witnessed three of the facility’s employees assaulting a patient. The police conducted an investigation and interviewed dozens of patients who were held against their will and who had witnessed other patients, including children, being assaulted.

Authorities throughout the country have had Acadia on their radar for similar issues. This year, Utah authorities investigated dozens of reports of rapes and assaults, which resulted in Acadia closing its Highland Ridge Hospital location. In 2022, Tennessee health inspectors found Acadia falsely claimed a patient had been checked on every 15 minutes, despite being found in rigor mortis hours after he passed.

Acadia’s Response to the Allegations

Thus far, Acadia has denied the allegations that they detain patients for profit. Tim Blair, an Acadia spokesperson, maintained that “Quality care and medical necessity drives every patient-related decision at Acadia.” Blair stated that he could not comment on individual patients due to privacy laws, but said that the patient stories in the Times investigation “were not representative of many patients with positive experiences.” The spokesperson also stressed that, “Still, to be clear: Any incident that falls short of our rigorous standards is unacceptable, and actions are taken to address it.”