Bad Medicine for ‘Troubled Teens’ : Forced Private Hospitalization Is Abuse of Process

Less-than-subtle, pervasive radio and TV advertising regularly tries to convince parents who have “troublesome teens” that hospitalization is necessary. The ads reflect a disturbing trend in California--an increase in the admission of minors to private psychiatric facilities. As of 1988, more than 35,000 adolescents nationwide were in psychiatric treatment in the private sector. This figure has doubled since 1980, and the numbers are growing.

While few would doubt that hospitalization is necessary for minors suffering from severe or acute mental disorders, what were once considered “growing pains” have today become a malady requiring hospitalization.

State lawmakers for years have attempted to clarify the inconsistencies plaguing the laws of adolescent hospitalization. In 1977 the state Supreme Court ruled that a minor 14 years or older could not be confined against his or her will in a state mental hospital unless the minor is protected by specified due process rights. Among them, the court declared, was the right to an administrative hearing at which the minor could contest the commitment.

This was the so-called Roger S. decision, and although it applied only to state mental hospitals, it has had far-reaching consequences. County mental-health departments, for example, have been encouraged to implement admitting procedures based on the Roger S. decision in order to avoid inappropriate admissions.

Private facilities, however, have largely ignored the Roger S. decision. This strains the imagination: How can adolescents in public facilities have constitutional protections but adolescents in private care facilities do not enjoy these same rights?

Adults and juvenile-court wards who are committed by the state are granted procedural rights guaranteed under the Lanterman-Petris-Short Act of 1969. This legislation ended the indefinite commitment of the seriously mentally ill. It further provides due process and prohibits commitment to a state hospital unless a person is either gravely disabled or is a danger to himself or others because of a mental disorder.

There are no such protections for children whose parents initiate commitment to private hospitals. These children are in a legal twilight zone. Because their parents have “volunteered” them for hospitalization, they are regarded as voluntary patients, even if they protest their admission. Yet these adolescents lack a basic right of voluntary patients: the right to terminate treatment. And as voluntary patients they lack the due process protections afforded to involuntary patients.

Behavior we would normally associate with the growing pains of adolescence is enough to confine minors against their will.

The spread of drug and alcohol abuse in our society has combined with the lack of alternatives to hospitalization to contribute to the growing profitability of private psychiatric facilities.

Fueling the admission of minors to acute psychiatric hospitals are generous health insurance policies that cover psychiatric hospitalization. Insurance companies usually do not reimburse for the least restrictive treatment, such as outpatient therapy. It is no wonder that private hospitals have found it lucrative to provide inpatient treatment, charging up to $800 per day, for adolescents who might otherwise be treated as well or better through outpatient therapy.

Furthermore, evidence suggests a correlation between the length a minor stays locked in a facility and the number of days health insurance provides for inpatient care, suggesting that many facilities will keep a minor as a patient only for as long as it is lucrative.

The TV and radio promotions for “troubled teens” facilities only increase the probability that unnecessary admissions are occurring. Under the pressure of competition for profits, ethics and constitutional rights may be trampled.

Legislation is required to protect the due process rights of all minors. There exists a clear need to balance the rights of parents to direct the upbringing of their children and the rights of these minors to avoid the stigma and unnecessary loss of liberty attached to psychiatric hospitalization.

Determination that a minor suffers from a mental disorder requiring inpatient treatment must incorporate protections against a hasty or biased decision resulting in the placing of a child in a locked facility.

Admitting criteria for private facilities should borrow from the Roger S. decision and include a review process with an advocate participating on the minor’s behalf. An independent decision-maker would then review the evidence and consider alternatives to inpatient treatment.

The costs of such a review would be minimal compared to expensive and all-too-often unnecessary hospitalization. Economic incentives need to be altered so that insurance coverage reimburses for less restrictive alternatives as well.

Curbing the rising number of adolescent psychiatric admissions begins by providing due process protections to our children. Big business and big profits should not stand in the way of basic constitutional rights.