Britney Spears's Forced Psychiatric Treatment Can Be Very Expensive
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Britney Spears bristled when she revealed that she was forced to receive psychiatric treatment at a cost of $60,000 per month. Although Britney Spears' financial circumstances are not typical, hundreds of thousands of psychiatric sufferers receive involuntary care every year. Many are left with the bill.
It can have disastrous consequences for those who don't have the resources to pay Spears.
Unfortunately, there is not much data available on the number of people who are hospitalized involuntarily and the cost of treatment. This frustrates those who study the topic. According to what we know, there are approximately 2 million people with substance abuse or other mental disorders in the United States each year. Nearly half of these patients are admitted involuntarily. A study showed that 25% of these hospitalizations were covered by private insurance. This often has high copays and 10% were "self pay/no cost," which means patients are sometimes billed but are unable to pay.
Hospitals may absorb some of the costs, but patients could be left with damaged credit, endless collection calls, and mistrust in the mental health system. Patients who are not present in court can be held at risk if a hospital files a lawsuit.
The cost of care is never discussed
I am a New York City psychiatrist and have treated hundreds of patients who were involuntarily hospitalized. The cost of treatment is almost never discussed. Patients with severe mental illness are often low-income, which is not like Britney Spears. My colleagues were most likely to respond in an informal survey. If patients are at risk of causing serious harm to others or themselves, psychiatrists must admit them to the hospital. This is even if they do not want to and it may cause financial hardship for their families.
Hospitals may absorb some of the costs, but patients could be left with damaged credit, endless collection calls, and mistrust in the mental health system. Patients who fail to appear in court can be sent to jail if a hospital decides that they will sue. Unpaid bills could encourage a hospital's side to close psych beds and offer more lucrative services such as outpatient surgery or better insurance reimbursement.
"They preyed upon my desperation."
Rebecca Lewis, 27, a Ohioan, has been dealing with the personal cost of involuntary hospitalization since her first admission as a psychiatricpatient.
Lewis started experiencing auditory hallucinations at 24. She was able to hear people calling her names. Then she began believing in mythological creatures. These experiences felt very real, but she knew something was wrong.
Lewis didn't know where to turn so she called a crisis number. The person on the other end advised Lewis to visit a Columbus evaluation center. She found an ambulance waiting for Lewis when she drove her car there. She says that they told her to get in the ambulance and that it would be worse if she ran.
Lewis was eventually diagnosed with schizophrenia and was forced to stay in hospital for two days. She refused to sign paperwork confirming her responsibility for the charges. Although Lewis was given her credit card in an emergency, the hospital tried to get it back from her mother, but she refused. Later, she received a $1700 bill by mail. She didn't contact the hospital to discuss the bill as she said, "I didn't have the emotional energy to go back to that battle."
Lewis continues to receive debt collection letters and calls. She answers the phone calls and explains that she doesn't intend to pay because she was forced to. Her credit score is not good, but she was still able to purchase a house through a relative. She considers herself fortunate, considering how difficult it would have been for her to get a mortgage.
Her psyche is weighed down by the medical debt. It's hard to believe that there is something out there that I won't be able to fix. She says that she feels like she has to be extra cautious because there will always be this debt.
Lewis is now receiving outpatient psychiatric treatment that has stabilized and prevented her from being hospitalized again. But, she still views her first and only hospitalization with dismay. She says, "They preyed upon my desperation."
Although it's likely that Lewis' story is shared by many others, there are no reliable data about the amount of debt incurred for voluntary psychiatric treatment. According to Dr. Nathaniel Morris (an assistant professor of psychology at the University of California in San Francisco), we don't know how many patients end up paying for involuntary care. Data on the number of people hospitalized against their will is also limited.
Morris is one of few researchers to have devoted their research to this topic. After his patients spoke out about involuntary hospitalization, he became interested. These bills presented an ethical dilemma for him.
He says, "I have been asked by patients how much their care will cost. One of the worst things is that I, as a doctor, often can't tell them due to our complex medical billing systems." It just gets more complicated when you add in the voluntary psychiatric element.
Patients who are overwhelmed by the demands of their lives rarely consult a lawyer.
Similar to the above, there are few legal rulings regarding whether individuals should be held responsible for payment if they are involuntarily hospitalized. Ira Burnim is the legal director at the Bazelon Centre for Mental Health Law. "I have only seen a handful" of these decisions. "I don’t know if there is a consensus."
Burnim states that people who are involuntarily hospitalized don't often seek out a lawyer. However, when they do, debt collection agencies will usually drop the case instead of pursuing a costly legal fight.
Britney Spears' case continues to be a hot topic this week. She may reveal more details about her conservatorship, which will bring attention to the dire situation of many people forced into care.
Other people won't receive that level of attention. Rebecca Lewis said it best when she reflected on her decision to not challenge the bills she faced: "They are Goliath, and I'm little David."
Dr. Christopher Magoon, a Columbia University Department of Psychiatry resident in New York City, is a physician.
