The part of the ‘Free Britney’ saga that could happen to anyone

When Britney Spears last appeared before a judge in June, she bristled when she said she was forced into psychiatric treatment that cost her $ 60,000 a month. While the pop star’s situation in financial guardianship is unusual, every year hundreds of thousands more psychiatric patients also receive involuntary care, and many must foot the bill.

Few have the resources of Spears to pay for it, which can have devastating consequences.

To the frustration of those studying the matter, data on how many people involuntarily hospitalized and how much they pay are scarce. From what we can infer, approximately 2 million psychiatric patients are hospitalized each year in the United States, almost half of them involuntarily. One study found that a quarter of these hospitalizations are covered by private insurance, which often has high co-payments, and 10% were “self-pay / no-cost”, where patients are often billed but cannot. not pay.

I am a psychiatrist in New York and have treated hundreds of involuntary hospital patients. The cost is hardly ever discussed. Many patients with severe mental illness have low incomes, unlike Britney Spears. In an informal survey of my colleagues on the question, the most common answer is: “Yes, this is not right, but what else can we do? When patients are at extremely high risk of harm to themselves or to others, psychiatrists are forced to hospitalize them against their will, even though this can cause long-term financial hardship.

While hospitals sometimes absorb the costs, patients can end up with ruined credit, endless fundraising calls, and additional mistrust of the mental health care system. In cases where a hospital chooses to prosecute, patients may even be incarcerated for not appearing in court. On the hospital side, unpaid bills could further incentivize a hospital to close psychiatric beds in favor of more lucrative medical services, such as outpatient surgeries, with better insurance reimbursement.

Rebecca Lewis, a 27-year-old Ohioan, has struggled with this problem for as long as she has been in psychiatry. At 24, she began to experience auditory hallucinations from people calling her by name, followed by delusional beliefs about mythological creatures. Although these experiences seemed very real to her, she knew something was wrong nonetheless.

Not knowing where to turn, Lewis called a crisis line, who told him to go to an assessment center in Columbus. When she got there, she found an ambulance waiting for her. “They told me to get in the ambulance,” she said, “and they said it would be worse if I ran.”

Lewis, who was eventually diagnosed with schizophrenia, was hospitalized for two days against her will. She refused to sign documents admitting responsibility for the charges. The hospital attempted to obtain her mother’s credit card, which Lewis had received in an emergency, but she refused to hand it over. She later received a $ 1,700 bill in the mail. She did not contact the hospital to negotiate the bill because, she said, “I didn’t have the emotional energy to come back to this battle.”

To this day, Lewis receives calls and letters from debt collection. When she picks up the calls, she explains that she has no intention of paying because the services have been imposed on her. Her credit is damaged, but she feels lucky that she was able to buy a house for a relative, given how difficult it would have been to get a mortgage.

Debt weighs on his psyche. “It’s no fun knowing there’s this thing out there that I don’t think I can fix. I feel like I have to be very careful – always, forever – because there is going to be this debt, ”she said.

Lewis receives outpatient psychiatric care that has stabilized her and prevented further hospitalizations, but she still looks with contempt on her first and only hospitalization. “They took advantage of my desperation,” she said.

While it is likely that several thousand Americans will share Lewis’ experience, we lack reliable data on indebtedness incurred for involuntary psychiatric care. According to Dr. Nathaniel Morris, assistant professor of psychiatry at the University of California-San Francisco, we don’t know how often patients are billed for involuntary care or how much they end up paying. Even data on how often people are involuntarily hospitalized is limited.

Morris is one of the few researchers to have looked into this question. He became interested after his patients told him they were billed after compulsory hospitalization, and he was struck by the ethical dilemma these bills represent.

“Patients ask me how much their care is going to cost, and one of the most horrible things is, as a doctor, I often can’t tell them because our medical billing systems are so complex,” he said. -he declares. “Then when you add the involuntary psychiatric factor, it takes it to another level. “

Likewise, legal decisions on the matter are rare. “I’ve only seen a handful of decisions over the years,” said Ira Burnim, legal director of the Bazelon Center for Mental Health Law. “I don’t know if there is a consensus.

People who have been hospitalized against their will rarely seek a lawyer, Burnim said, but when they do, debt collection agencies often drop the case rather than face a costly legal battle.

The media will be obsessed with Britney Spears’ day after in court, which is scheduled to be September 29. She will probably describe more details about her guardianship which will highlight the plight of many people forced into care.

Others won’t get that kind of attention. As Rebecca Lewis said, reflecting on her decision not to dispute the bills she faces: “It’s Goliath and I’m little David.

Dr Christopher Magoon is a resident physician in the Department of Psychiatry at Columbia University in New York.

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Julio V. Miller

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