Mental Health Inc Read online

  HOW CORRUPTION, LAX OVERSIGHT AND FAILED REFORMS ENDANGER OUR MOST VULNERABLE CITIZENS

  ART LEVINE

  The mental health system in America is hardly the front-burner issue it should be, despite lip service about reform after each new tragic mass killing. Yet every American should care deeply about fixing a system a presidential commission reported was in “shambles.” By some measures, 20 percent of Americans have some sort of mental health condition, including the most vulnerable among us—veterans, children, the elderly, prisoners, the homeless.

  With Mental Health, Inc., award-winning investigative journalist Art Levine delivers a Shock Doctrine-style exposé of the failures of our out of control, profit-driven mental health system, with a special emphasis on dangerous residential treatment facilities and the failures of the pharmaceutical industry, including the overdrugging of children with antipsychotics and the disastrous maltreatment of veterans with PTSD by the scandal-wracked VA.

  Levine provides compelling narrative portraits of victims who needlessly died and some mentally ill people who won unexpected victories in their lives by getting smart, personalized help from “pyschosocial” programs that incorporate safe and appropriate prescribing, along with therapy and social support. He contrasts their stories with corrupt Big Pharma executives and researchers who created fraudulent marketing schemes. Levine also tells the dramatic David vs. Goliath stories of a few brave reformers, including Harvard-trained psychiatrist and researcher Dr. Stefan Kruszewski, who has acted as a whistleblower in several major cases, leading to important federal and state settlements; in addition, the book spotlights pioneering clinicians challenging outmoded, drug-and-sedate practices that leave 90 percent of people with serious mental illness too disabled to work.

  By taking a comprehensive look at mental health abuses and dangerous, ineffective practices as well as pointing toward solutions for creating a system for effective, proven and compassionate care, Art Levine’s essential Mental Health, Inc. is a call to action for politicians and citizens alike—needed now more than ever.

  Copyright

  This edition first published in hardcover in the United States in 2017 by

  The Overlook Press, Peter Mayer Publishers, Inc.

  NEW YORK

  141 Wooster Street

  New York, NY 10012

  www.overlookpress.com

  For bulk and special sales, please contact [email protected], or write us at the above address.

  Copyright © 2017 by Art Levine

  All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system now known or to be invented, without permission in writing from the publisher, except by a reviewer who wishes to quote brief passages in connection with a review written for inclusion in a magazine, newspaper, or broadcast.

  ISBN 978-1-4683-1531-8

  In memory of Sylvia Levine, Andrew White, Jason Simcakoski, Rebecca Riley, Genine Zizzo and all those countless others who deserved quality care—and never received it.

  For all those people struggling with serious mental illness and substance abuse.

  For all the clinicians, whistleblowers and reformers dedicated to making our mental health system work for everyone.

  For all those who shared their personal stories, research and insights to make this book possible.

  CONTENTS

  COPYRIGHT

  DEDICATION

  INTRODUCTION

  1. Drugging Our Kids: Corporate Greed Joins Corruption, Apathy

  2. Nursing Homes: Drugging Our Seniors to Death

  3. The Secret History of the VA’s Tragedies in Tomah and Phoenix

  4. The Secret History of the VA Scandals,

  Part II: The Empire Strikes Back

  5. A Marine’s Descent into PTSD Hell

  6. Stan White and the Veterans’ Search for Truth and Answers

  7. Mr. White Comes to Washington: FDA Showdown over Seroquel

  8. Drug-Free PTSD Recovery

  9. How LA County’s Mental Health Officials Neglect Inmates and Ignore Violence

  10. To Live and Die in LA: How DMH’s Outreach Work Saves Lives, Stops Mass Shootings

  11. Torture in Alabama

  12. Profits and Losses from Residential Treatment: The Story of Bain Capital and CRC Health

  13. Recipe for Disaster?: Residential Treatment Programs for Addicts and Kids

  14. Florida: Free-Fire Zone for Killing, Abusing and Raping Kids?

  15. Karen’s Story and the Mental Health System That Never Was: Saving Families, Young People from Lifelong Madness

  16. Why Can’t We Just Do What Works?

  17. Putting People Before Big Pharma: Overcoming the Barriers to Recovery

  ENDNOTES

  ASSISTANCE, ADVOCACY AND INFORMATION RESOURCE GUIDE

  ACKNOWLEDGMENTS

  ABOUT THE AUTHOR

  INTRODUCTION

  AFTER THIRTY-EIGHT-YEAR-OLD ARMY VETERAN STEVE TOMPKINS CAME home early one April evening in 2014, it didn’t take much to set him off when he started arguing with his second wife in their home in South Charleston, West Virginia. (Tompkins’s name has been changed to protect his privacy.) The hulking six-foot-four, 350-pound man was bloated and a bit dazed from the high dosages of all the Seroquel, Depakote, Lithium and other drugs his doctors had thrown at him for nearly a decade since he returned from his final tour of Iraq, but the medications couldn’t quiet the depression, anger and the murderous thoughts that could explode at any time. He had been waiting for weeks to get into the specialized PTSD sixty-day unit at the Clarksburg Hospital, and could barely take all the strains in his life anymore: the fights with his ex-wife over visiting rights with his teenage kids, his despair and the stress of being constantly broke with two young children. “I was overwhelmed,” he recalls. “All I was doing was throwing out red flags.” So when his wife, Jolene, told him they didn’t have $40 to pay someone to cut their overgrown lawn, and added that he shouldn’t have spent $200 on a wood lathe, a dark cloud of rage and anguish gripped him. “I can’t take this pain anymore,” he declared, hurrying up the stairs to get the guns.

  Tompkins moved quickly and methodically, changing into black fatigues for his final mission. He strapped on a green Army chest rig and jammed in seven extra thirty-bullet magazines to go with the AR-15 assault rifle and the .40- and .45-caliber pistols that he grabbed from his personal armory of two dozen rifles and guns; he also attached a pouch to his belt to hold even more semiautomatic rounds. His wife, their two-year-old girl and their six-year-old boy started crying when he came down the stairs and ordered them out of the house. Jolene refused, knowing that if they left, he would surely kill himself and take out anyone who tried to stop him. As they were arguing, his ex-wife called from Georgia to remind him that his thirteen-year-old son’s birthday was the next day. He asked his son to come to the phone and he told him, “Hey buddy, I’ll see you on the flip side in Valhalla.” His ex-wife, picking up on the farewell to his son, immediately began crying and hung up the phone. Then she called the South Charleston police emergency line. About five squad cars were dispatched. The police cars pulled up outside, the cops got out of their cars and took cover, ready to train their guns on Tompkins if he stepped out of the house.

  Inside, Tompkins was still urging his family to leave when Lt. Guy Amburgey, a military veteran and a skilled negotiator, called the Tompkins home, got Jolene on the phone, and tried to convince her to leave, with Tompkins following—unarmed. “He’s not going to do that,” she said, as recounted in the police report, and she didn’t agree to leave, either. Tompkins stood nearby, looking out the window and waiting f
or the right moment to rush out and start shooting, willing to go out in a hail of bullets rather than go to jail or keep on living with his PTSD and unending misery. Finally, he warily got on the phone with Amburgey, who said he wanted to help Tompkins and his family, but needed him to come outside.

  “Do you believe a man is as good as his word?” Amburgey asked, veteran to veteran.

  Tompkins agreed, and Amburgey vowed that he wouldn’t be put in a police van, but would be taken in an ambulance to a hospital. As Tompkins waited impatiently, Amburgey, talking to him with his cell phone in hand, approached the front door from the side of the house. Tompkins agreed to come out, but only if guns weren’t pointed at him. As Tompkins stepped out onto the porch, arms raised, the police officers on the street started shouting commands and leveling their guns at him. Feeling betrayed, the veteran shouted, “Let’s end this. Fuck you all!” At that, Amburgey whipped around to face his fellow officers and pumped his arm downward, shouting, “Put your fucking weapons down!” The two of them then resumed their negotiations and Tompkins agreed to walk to the side of the house to meet Amburgey, but not before he pulled up his shirt to show that he didn’t have bullets strapped to his chest or any weapons on him. The lieutenant patted him down and found the pouch with the magazine rounds. Amburgey asked him to walk to the end of his sidewalk, sit down and wait for the medics.

  At that point, Tompkins, who was as tough as anyone when he was an M1 tank crewmember fighting in Iraq, began to cry. “I’ve been trying for weeks to get help there and everything is full,” he moaned. “It’s too bad it takes something like this to get help.” More than a year later, he was still waiting for admission to the special PTSD inpatient program.

  • • •

  THE CONVENTIONAL VIEW OF THE STORY OF STEVE TOMPKINS—AND THE roughly 30 percent of all Iraq, Afghanistan and Vietnam vets treated by the Department of Veterans Affairs (VA) who have PTSD—is simple: Their lives would be vastly improved if there were only enough funds available so that these troubled vets could get access to the specialized care, cutting-edge medications and psychiatric care they deserve without facing long waiting lists. The VA’s mental health funding, in fact, increased more than 40 percent between 2009 and 2016 to $7.4 billion a year, and thousands of new clinicians were added.

  Even so, reform advocates believe that the shortage of funding for our nation’s mental health system is at the root of a broader crisis—usually without acknowledging the prevalence of low quality and sometimes deadly care. For example, as the National Alliance on Mental Illness (NAMI) declares, “Services are often unavailable or inaccessible for those who need them the most.” To be sure, access to affordable and trained mental health providers—from social workers to psychiatrists—remains woefully lacking: a stunning 55 percent of American counties, all rural, don’t have a single mental health professional, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

  The shocking arrival of Donald Trump’s presidency, of course, presents an even broader barrier to mental health care. The best-known roadblock, obviously, is the potential stripping of health insurance from about twenty-three million Americans as part of the Republican drive to “repeal and replace” key features of Obamacare, also known as the Affordable Care Act (ACA). This goal was at the heart of the Republican bill that narrowly passed the House of Representatives in May 2017.

  By the summer of 2017, the Republican’s American Health Care Act (AHCA) fate in the Senate remained uncertain, but one thing was clear: countless Americans were still at risk of losing either their benefits or health care coverage. Just as troubling, more than 130 million people have preexisting conditions, and those with the most serious health problems could find it nearly impossible to afford private insurance under the GOP health care provisions that would lift restrictions on charging older or sicker people higher premium costs, according to the liberal Center for American Progress (CAP). In one striking CAP assessment, new rules in the Republican bill allowing insurers to charge far higher fees would cost a typical forty-year-old individual a “premium surcharge” of $8,370 for having a major depressive or bipolar disorder—and an extra $20,000 a year if the person is an addict. That’s particularly grim news when over 140 people a day are dying from drug overdoses. Under the bill and planned federal waivers, even many lower-income or severely mentally ill people without coverage could well find their opportunity to enroll in Medicaid blocked in those states granted Medicaid waivers.

  Amid the political furor that engulfed Washington after President Trump fired FBI director James Comey, even less media and public attention is being paid to the administration’s backstage regulatory assaults on health care coverage that could harm millions of people with mental illness and addictions. These dangers remain even if a full-scale Obamacare repeal law never makes it through Congress.

  The first version of the wildly unpopular bill designed by House Republican Speaker Paul Ryan drew fire from all sides of the political spectrum and won support from only 17 percent of the public. The measure was withdrawn in March 2017 because it couldn’t get enough votes. But the damage to Obamacare’s protections and subsidies were already well underway after Trump took office—even before Republicans in the new Congress turned to repealing Obamacare.

  President Trump, administration health officials and Republican leaders have shown by word and deed their clear intentions to undermine both Medicaid and the ACA by any means at their command. “The best thing we can do politically is let Obamacare explode,” Trump told reporters on the same day that the first repeal effort failed. “It’s imploding, and soon will explode, and it’s not going to be pretty.” The repeal campaign, whether through legislation or deregulation, also aims to wipe out Obamacare’s extended Medicaid coverage in over thirty states for about fourteen million people who weren’t previously covered—and almost all of them would lose their coverage under the GOP repeal bill that passed the House. Virtually all Medicaid recipients still remain at risk of losing either their current benefits or coverage, through some combination of federal waivers granted the states and whatever bill reaches Trump’s desk.

  The administration and Republican leaders have a vested interest in failure: they have done whatever they could to hasten Obamacare’s demise and limit the scope of Medicaid, threatening coverage for at least four million people with mental and substance abuse disorders who were previously uninsured, according to federal and academic estimates. Even before Trump was elected, Congress passed in 2014 a little-noticed measure crafted by Sen. Marco Rubio (R-Fla.) that drastically cut $8 billion worth of reimbursement to insurance companies for losses they incurred when expanding their Obamacare coverage to sicker people, The New York Times first reported. A federal judge ruled against the government for its underpayment in February 2017, but that came too late for smaller companies that folded and a few major ones, including Aetna and UnitedHealth, that drastically reduced their involvement in the Obamacare marketplaces in 2017; Aetna has even announced it will leave all the ACA marketplaces by 2018.

  “The entire individual market, covering millions of farmers, ranchers and self-employed people, is at risk,” Timothy Jost, an emeritus law professor at Washington and Lee University, told a health care reform panel in April 2017. Citing a range of damaging steps already taken or considered by the administration, he said these endangered beneficiaries could “suffer financial instability and loss of health and indeed life if the market is destroyed.”

  If Obamacare were just allowed to continue, the Congressional Budget Office (CBO) found, the individual marketplaces covering twelve million people would be financially viable. That non-partisan finding also disclosed that the original failed “replacement” bill was essentially an $883 billion tax cut for the wealthiest individuals and health companies that drained $839 billion from Medicaid, but its analysis of the individual health-care market didn’t take into account Trump’s deliberate sabotaging of Obamacare.

 
The House-passed version was even more draconian than the first one that failed. The new bill gutted protections for consumers with preexisting conditions and allowed states to eliminate essential health benefits—including mental health and maternity care—even from corporate health plans. “The latest version of Trumpcare doesn’t just threaten access to behavioral health coverage for those on Medicaid, it threatens access to behavioral health coverage for everyone,” Rep. Joe Kennedy (D-Mass.) wrote in an op-ed for STAT, an online health news site.

  Regardless of the final outcome in Congress, the Trump administration’s early actions in office especially aimed at destroying the ACA on a variety of fronts. As his first executive order, he undercut active enforcement of the individual mandate needed to spur younger and healthier people to sign up; his Health and Human Services (HHS) department initially pulled $5 million in advertising designed to urge people to enroll; and the White House dithered in early 2017 about whether to support or oppose “cost-sharing” subsidies worth about $7 billion that limit such out-of-pocket costs as deductibles for the six million lower-income purchasers of marketplace plans. At first, after the first bill failed, Trump threatened to end those subsidies in an effort to blackmail Democrats into supporting a revised repeal bill. But then his administration agreed—temporarily—in April 2017 to continue paying them to avoid a government shutdown over a federal budget dispute. Without those subsidies, first challenged in a House Republican lawsuit against the Obama administration, the private marketplaces will almost surely collapse, most experts agree.

  Even before these latest attacks on Obamacare, the nonstop political attacks and congressional time bombs planted by Republicans led to a stunning decline in insurers in many states. A Vox survey found that the number of counties with only one insurer quadrupled to 960 in 2017 compared to the previous year, leading to exorbitant premiums and potentially no coverage at all in 40 percent or more of American counties. Recent polling shows that nearly two-thirds of Americans will blame Republicans if Obamacare fails. Nevertheless, Trump is sticking by his blame-the-Democrats strategy to further undermine whatever remains of Obamacare after his agencies and the Republican Congress have artfully used their power to starve the private marketplaces of funding, incentives and support.