The ads are provocative, the questions they pose deliberately unsettling: "Is your teen-ager running away without leaving home? Are you worried about your child? Is your teen-ager experimenting with sex? drugs? alcohol?" In every case, the answer is the same: Help is as close as the private psychiatric hospital.
These ads and dozens of others that prey on parental fears have contributed to thousands of unnecessary admissions of children and adolescents to expensive, for-profit psychiatric hospitals during the past decade, witnesses last week told a congressional panel investigating insurance fraud and treatment abuses.
Many of these ads--the centerpieces of aggressive, multimillion-dollar marketing campaigns--suggest that rebellious, moody and even unconventionally dressed adolescents, disobedient children and those with poor grades might be seriously mentally ill.
"There is no question that in some cases hospitalization is exactly the right thing to do," said Jerry M. Wiener, chairman of the department of psychiatry at George Washington University Medical Center. "But I also don't have any question that many kids are slapped into the hospital" for experimenting with drugs or rebelliousness that typifies adolescence.
Between 1980 and 1986, admissions of juveniles to private psychiatric hospitals nearly tripled, rising from 17,000 to 43,000, according to the National Institute of Mental Health. Critics say this rapid expansion of inpatient psychiatric care for children and adolescents was fueled by parental insecurities, the elasticity of psychiatric diagnoses, the willingness of insurance companies to pay for hospitalization and relentless marketing by the hospitals themselves.
Last year, legislators in New York passed a law requiring the commissioner of mental health to draw up "reasonable restrictions" on marketing and advertising by hospitals that treat teen-agers.
"Parents see ads that ask, 'Is your child this or that?' and of course, it's going to affect many of them," said Wiener, past president of the 5,000-member American Academy of Child and Adolescent Psychiatry.
One ad cited at last week's hearing before the House Select Committee on Children, Youth and Families depicted a report card studded with Fs. The ad routinely ran in a Reno, Nev., newspaper the day report cards were issued and was particularly effective, according to the former school board chairman, Kevin Christensen.
"I would get a lot of calls from people saying, 'My kid got a report card like that, and he doesn't pay attention. Should I take him to the hospital?' " said Christensen, now director of Nevada's Protection and Advocacy Office, a federally funded program that investigates abuse and neglect in mental health facilities. "It scared the wits out of people, but it was very effective and it kept those beds full."
That is the purpose of such ads, according to Laurie Flynn, executive director of the National Alliance for the Mentally Ill, an advocacy group with 140,000 members, most of them relatives of the chronically mentally ill. "These ads are outrageous," she said. "They manage to trivialize serious mental illness and are a rip-off of unsuspecting families with insurance who are made to think that adolescence is a disease."
Carole Szpak, communications director for the National Assn. of Private Psychiatric Hospitals, the industry's Washington-based trade association, disputed the contention that advertising results in hospitalization.
"Our surveys have shown that the vast majority of people come to the hospital because they are referred by professionals," not because they are enticed by an ad, she said.
The association has issued voluntary guidelines recommending that ads avoid "sensationalism or oversimplification."
Among the facilities mentioned at last week's hearing are those operated by two large chains: National Medical Enterprises of Santa Monica, which owns Psychiatric Institutes of America, and Charter Medical Corp. of Macon, Ga.
The marketing practices of these chains are under investigation by the Texas attorney general's office. In 1990, the Wall Street Journal reported that Charter, which owned 90 hospitals, spent $40 million on advertising.
Many of the ads submitted to the committee focused on a handful of psychiatric problems for which hospitalization is rarely--if ever--recommended, including attention-deficit hyperactivity disorder.