Mental Illness and the US Sickness Industry

Christmas 2018: This is one cause of mental illness.

Richard Mellor
Afscme Local 444, retired

I have a few friends who have relatives with severe mental illness. One of them, whose son is schizophrenic, said her life was a nightmare with him being in and out of prison after the police pick him up. He was also too big for her to manage now. She organized a tour (access was not easy I believe) of the mental health section of one of the prisons here in California and I went along. Another who was looking for a home for her relative said that some of the places she visited were so poor she wouldn’t leave him there. But many families, especially individuals, do not have the ability to care for someone with such severe illness

In capitalist society nothing is set in to motion unless it is profitable and that includes health care. This is particularly acute in the US where the private sector is so powerful and workers have never had a political party of our own. The mentally ill are a burden and without social power, so they are among the most victimized sections of society.

I took the picture of the woman sleeping included here as I walked past her on Christmas Day. It was pretty cold that day. I figure that if you are not mentally entering in to such situation it is quite likely you will become so through the experience.

The Sickness Industrial Complex
In the US, 90% of the nation’s psychiatric hospitals are evaluated and accredited by The Joint Commission, which is a private, so-called non-profit. It is authorized to do so by the federal government. The Wall Street Journal, which has been reporting on the state of affairs in these hospitals discovered that the Commission, “…. revoked or denied full accreditation to fewer than 1% of psychiatric hospitals it oversaw in fiscal 2014 and 2015….” Once a hospital is accredited by this private watchdog it can use the accreditation to attract new patients, and that’s good for business. So the federal government and the patient relies on a private institution for the care of the mentally ill. That’s where the problem lies of course.

The WSJ investigation revealed that, “Psychiatric hospitals kept their accreditation after patients said they were raped or assaulted; died by suicide; or slept on chairs due to crowding, among other incidents…”, and, like health care overall, there’s a lot of money in the mental health business with Medicare payments to inpatient psychiatric facilities hitting $4.5 billion in 2017.  The hospitals pay the Commission for the inspections that will, if the inspection passes, be able to attract new business. Quite naturally there are some serious criticisms of this method:

 “Accrediting bodies can’t make the standards too high or no one will ever pay for it…….Accreditors are all in the business to make money.” Benjamin Miller, an advocate for mental health.

The WSJ report found 141 psychiatric hospitals out of 490 nationwide that were passed and accredited by the Commission that had received numerous (dozens in some cases) of abuse and safety violations, an average of eight since 2011.

Here the Journal gives an example of some of the abuses:

“Those later violations include sexual assault, the alleged rape of a teenage patient, the administration of psychotropic medication without consent and failure to give insulin to diabetic patients, according to state inspection records. State inspectors said one patient sustained a skull fracture because the hospital failed to implement safety measures. Another hospital failed to adequately investigate when a staff member used a phone to take pictures of a patient’s breasts, inspectors said.”

We should not be surprised at this, it is their precious market at work. In one case, a psychiatric facility owned by Universal Health Care, one of the largest health care companies in the country, a patient’s death was classified as a homicide by the medical examiner. Previously, UHS paid over $6.9 million to resolve allegations that they submitted false and fraudulent claims to Medicaid between October 2004 and March 2010 

Despite this, the institution concerned has been accredited by The Commission and as we can see, UHC is doing quite well this year as financial reports show, “…total revenues in the third quarter is pegged at $2.7 billion, reflecting year-over-year growth of 5.5%. The consensus estimate for net revenues at Acute Care and Behavioral Health segments stands at $1.4 billion and $1.2 billion, respectively, up by 5% and 3.8% each, year over year.”

Another institution that was cut off from Medicare after receiving $20 million in funding since 2014 due to repeated violations, was accredited by The Commission and received its  “Gold Seal of Approval” that it proudly displayed on its website. According to the WSJ the hospital is now closed.

It is bad enough that those protecting the interests of some of the most vulnerable sections of society are private bodies. But the entire US medical system is a business, in reality it is more accurate to refer to it as the sickness industrial complex.  Many Americans think that the high cost is due to the health care being better in the US than all other advanced capitalist countries but it is not. The US mass media is very powerful and in many ways, the population of the US, despite having a global footprint are very isolated and unaware of the rest of the world.  The US ranks 28th, below almost all other rich countries, when it comes to the quality of its healthcare assessed by UN parameters.

As is always the case, the case, it will not be the market or the system that will be pointed to as the reason US health care is so pathetic and yet so expensive. Character flaws, personal behavior, corruption in the abstract will be addressed but not capitalism, not the private sector placing profits before needs. The profits in the US sickness industry are staggering.

Don’t blame the worker
And while there is no doubt that an unregulated and shoddily managed industry can attract poorly skilled and unqualified or even vindictive and abusive workers, it is not the workers that are to blame either. Most of the people that work in this industry are decent human beings and they do the best they can in an incredibly difficult work environment caring for mentally ill, often violent and suicidal human beings. I recently visited a friend in an Alzheimer’s facility. She didn’t recognize me and has since died. But I watched the staff feeding them at lunch, these were mostly Latino workers, another section of the working class blamed for the market’s failures. What will these workers do if Trump’s wall is successful? I don’t think they’re “stealing” our jobs especially when wiping the backsides of elderly people who can’t do it is in the job classification.

I told these workers how my friend was a shop steward and fought for people like them. She was 88 yet she was as I knew her, a woman full of energy and fight for working class people, one wouldn’t believe it to see her now. I told the woman at the main desk who I think was in charge and she said she would pass all this on. 

In capitalist society we are taught from day one to exploit weakness, to exploit any chink we can find in people who are foolish enough to go against their natural human instinct to trust others and act in a collective humane way. This is a significant cause of mental illness in capitalist society. Capitalist society makes us sick as sure as polluted water does a fish.

It is natural for human beings to care for the weak or the sick. What tragedy a major illness is for a family as they are left dealing with a dependent person parent or child as they have to work, take care of other children, pay the rent etc.  I just saw the movie Alive Inside  and while it has its weaknesses by not seeing the problems of helping Dementia or Alzheimer patients and their families as a social issue and that society as it is will never do that, it is a very good film that exposes the insanity of for profit medical care of any sort. The main character in the documentary worked in a facility and discovered that patients who were dead to the world came awake with music and a set of cheap headphones. Some of the scenes are incredible as patients dead to the world wake and become animated and talk about memories they were supposed to have lost.

As one doctor put it, he can write a thousand or more prescriptions for ant-psychotic drugs but trying to get funding for a $40 I-Pod and some headphones, forget it.  These are not homes but factories and the patients doped up and kept alive, but someone pays.

Just as it should be with any public social needs, health care cannot be a business. The health care and drug addiction industry should be taken out of private hands. To work it should be controlled and managed by those who use it, those that work in it, and representatives of the communities that are served by it.  The reality is of course that capitalism will not solve this problem.  Capitalism causes many of the illnesses that plague us not just mental illness.

We demand universal health care but big Pharma, the health industries, many doctors and other powerful lobbying groups will block this as they always have. Not only is the controlling power in the Democratic Party fighting universal government funded health care they are watering it down. The Democratic Party cannot even stop the endless ads for prescription medicine and pills that we are bombarded with every night on TV with the call to “call your doctor and ask them “ if the medicine advertised is right for you. A retired pediatrician friend of mine told me she was asked about a disease she’d never heard of, the patient had seen it on TV. “Restless Leg Syndrome anyone.” ?

This stuff will never end folks, until we put a stop to it.