LOS ANGELES - Marylandian -- Citizens Commission on Human Rights International, a mental health industry watchdog, applauded the recent Senate Committee on Finance report exposing youth residential treatment facilities (RTFs). The report is the culmination of Committee Chair Ron Wyden's two-year investigation, uncovering systemic child abuse and neglect in youth RTFs funded by federal dollars, including Medicaid and child welfare funding. It revealed RTFs routinely subject children to abuse, inappropriate restraints, unsafe conditions, and inadequate behavioral health care.[1]

The groundbreaking 136-page report, "Warehouses of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities," released on 12 June 2024, is testimony to the horrific abuse in the for-profit youth mental health system, about which CCHR has been informing legislators since 2015.[2]

CCHR agrees with Senator Wyden's solution to "shut off the fire hose of federal funding" for the industry.[3] The group's international president, Jan Eastgate, adds that stiffer regulations and strong penalties for violations are needed to protect children.

"The harms, abuses, and indignities children in [residential treatment facilities] have experienced and continue to experience today occur inevitably and by design: they are the direct causal result of a business model that has incentive to treat children as payouts and provide less than adequate safety and behavioral health treatment in order to maximize operating and profit margin," the report states. Further, "Providers will continue to operate this model because it's good business, unless there is some bold intervention."[4]

In 2020, CCHR reported at least 32 cases of sexual abuse in facilities owned by one of the hospital chains, including several convictions of staff responsible; about 18 abuses involving seclusion rooms or restraints use in children as young as 6, and including 3 deaths; wrongful deaths, assault; breaking a patient's arm and fracturing the nose of another; and, at least 6 suicides that may have been preventable.

According to the Centers for Disease Control and Prevention, there are 30,600 residential care communities in the U.S. with a total of 1,197,600 licensed beds across the country, of which 81.9% have for-profit ownership.[5]

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The investigation concentrated upon four major operators—Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare (formerly known as Sequel). The companies turned over 25,000 pages of documents to the committee.

Senate staff visited some facilities in person, in what they describe as a representative sample of the industry. "Some kids they met were so heavily dosed on psychotropic drugs they appeared to move in a daze and struggled to hold conversations. A nurse at one site told investigators most kids took five to eight medications," The Imprint reported.[6]

The troubled teen treatment industry was found to prioritize cost-cutting, which often resulted in severe trauma or even death for the children involved. The report concluded that sub-par conditions are baked into the taxpayer-supported business model of many RTFs, costing taxpayers or parents as much as $1,200 a day per child.[7]

"The findings are simply horrific. And the report shows a terrible pattern of mistreatment and abuse happening to kids — at facilities which now receive billions of dollars in federal funds," Wyden said. "Overwhelmingly, it's clear that the operating model for these facilities is to warehouse as many kids as possible while keeping costs low, in order to maximize profit," stated Wyden.[8]

The presentation of the report enlisted the support of Paris Hilton, a staunch critic of the at-risk youth industry, following her own experience in a Utah facility as a teen. Hilton's group organized survivors of behavioral treatment facilities to submit testimony for the record, which Senator Wyden acknowledged during the hearing, holding up a thick stack of testimonies that had been submitted.

"After reading it [the report], I honestly have never felt so seen and heard: it validates everything that I've been fighting for over the past four years," Hilton said in a video statement released. She implored legislators to act: "I am begging you to protect your constituents before it's too late."[9]

The report said many states' historic reliance on RTFs was inappropriate and called on them to "ramp up their oversight capabilities for youth in both in-state and out-of-state facilities."[10]

Eastgate commented, "The recommendations are a huge step towards safeguarding troubled children and teens but may need even stronger reforms." But, she says, the implications are much wider, citing the death of a 12-year-old boy at a Trails wilderness camp in North Carolina in February this year, within 24 hours of admission. A petition has called for the facility's closure.

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CCHR recommends added state protections, including:

As a requirement for acquiring a state license and/or contracting with the Center for Medicare and Medicaid Services (CMS), mental health and behavioral treatment facilities must ascribe in writing to a code of ethics and practice and legally swear to abide by it at all times, which includes agreeing to a policy of non-coercive or punitive practices.

Increase the penalties for hospitals and congregate treatment facilities which repeatedly violate plans of correction for deficiencies that put residents at risk. Penalties include hospital closure and significant fines.

Uniform state restraint laws to align with the October 2023 World Health Organization guidance on Mental Health, Human Rights and Legislation, that recommends laws "prohibit the use of seclusion and restraint in any health or social care facility."[11]

A national reporting system should be established similar to the Food and Drug Administration's MedWatch adverse drug reporting system, where hospital harm and abuse incidents can be posted.

Implement a policy that works towards the de-escalation and reduction of psychotropic drug use in these age groups, also prohibiting such drug use as "chemical restraint" to control behavior, and thereby help improve the lives of troubled children, teens and young adults.

About CCHR: CCHR was founded in 1969 by the Church of Scientology and Dr. Thomas Szasz, Professor of Psychiatry, State University of New York Upstate Medical University and helped achieve over 190 laws that protect patients from coercive psychiatric practices, including the Prohibition of Mandatory Medication Act to protect schoolchildren from enforced psychotropic drugs.

[1] www.wdbo.com/news/trending/senate-investigation-reveals-abuses-neglect-federally-funded-youth-treatment-centers/GTXWTKBKUZA5NCXKJDGL3NOVWM/; www.finance.senate.gov/chairmans-news/wyden-investigation-exposes-systemic-taxpayer-funded-child-abuse-and-neglect-in-youth-residential-treatment-facilities

[2] www.cchrint.org/2015/08/11/universal-health-services-timberlawn-hospital-could-close-jeopardy-to-patients/; www.cchrint.org/2016/04/04/concerns-increase-about-abuses-at-uhs-behavioral-centers/

[3] imprintnews.org/top-stories/senate-investigation-slams-residential-treatment-centers-for-children-as-warehouses-of-neglect/250056

[4] bhbusiness.com/2024/06/12/senate-finance-committee-releases-excoriating-investigation-of-abuse-in-at-risk-youth-industry/

[5] www.finance.senate.gov/imo/media/doc/rtf_report_warehouses_of_neglect.pdf, p.25

[6] imprintnews.org/top-stories/senate-investigation-slams-residential-treatment-centers-for-children-as-warehouses-of-neglect/250056

[7] imprintnews.org/top-stories/senate-investigation-slams-residential-treatment-centers-for-children-as-warehouses-of-neglect/250056

[8] imprintnews.org/top-stories/senate-investigation-slams-residential-treatment-centers-for-children-as-warehouses-of-neglect/250056

[9] bhbusiness.com/2024/06/12/senate-finance-committee-releases-excoriating-investigation-of-abuse-in-at-risk-youth-industry/

[10] bhbusiness.com/2024/06/12/senate-finance-committee-releases-excoriating-investigation-of-abuse-in-at-risk-youth-industry/

[11] www.cchrint.org/2023/09/18/who-guideline-condemns-coercive-psychiatric-practices/, www.ohchr.org/sites/default/files/documents/publications/WHO-OHCHR-Mental-health-human-rights-and-legislation_web.pdf