How the Factor of Profitability Determines the Psychiatric Diagnosis. Case Studies of Social Triage in the Texas Psychiatric Hospital Industry

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First hand accounts of private psychiatric hospitals policies and shows that there is often willful neglect of patients who do not have the money to pay, and sometimes there is even manipulation on behalf of psychiatrists and nurses to keep people in therapy just to run up their expenses with insurance companies, only to miraculously ‘cure’ them when their coverage runs out. Testimonial statements during congressional hearings are made available in this text, and the book describes what political fallout occurred, if any, once patients stepped forward to report their lack of care.


“What makes Dr. Glumm’s study particularly interesting is that she has identified a hybrid of sorts. The patients were vulnerable, they were experiencing the negative implications of social triage, but they were also positioned to fight back. They did not sit still. They invoked influential advocates to advance their cause. For that reason, it is an engaging, important story.”

-Prof. Sheldon Elkland-Olson
University of Texas at Austin

“Glumm throws light on the exploitive practices of social triage in today’s psychiatric facilities much like Dorthea Dix did 150 years ago. And much like those in Dix’s time we are shocked that patients are coerced into care simply because they provide the best revenue stream. The stories are compelling and underpin her thesis that psychiatric facilities triage patients by payment source and that some patients are forced into unnecessary treatment."

Prof. Christine Clarke University of North Carolina – Chapel Hill

“The move to privatization of services appears most times to be a strategy to save money by government. However, anytime that you cut funding for services it naturally causes bureaucracies to begin to look for ways to maximize revenue… I found this book to be interesting and focused on some very important issues which need to be further studied. As funding across the nation continues to be significantly cut for these as well as other services the potential for this social triage and exploitation will no doubt expand.”

-Prof. Lyla McGuire,
Executive Directcor CCAR Industries

Table of Contents

Chapter 1

Background Considerations
Guiding Questions
Direction of Research

Chapter 2
Theoretical Background
The Nature of Bureaucracy
Weberian Framework
Human Agents and Organizational Structures
Hierarchy, Discretion, and Blamability
Secrecy and the Bureaucratic Order
Bureaucracy and Social Triage


Chapter 3
History of Public/Private Funding
Entrance of State
Reduction in State Hospital Care
Prisons and Child Care

Chapter 4
Research Procedures
General Approach
Sources of Data
Taped Hearings with Transcripts
Work Sessions
Newspaper Articles
Data from Other States
Data from Similar Investigations
Interviews with Key Respondents

Limitations of the Data

Chapter 5
Process of Mobilization
Resource Mobilization
Initial Case
Continued Mobilization
Discussion of Mobilization

Chapter 6
A Comparison of Vulnerable and Privileged Vulerable
Navaho Indians
Former Psychiatric Patients
Large Markups for Services
Disputed Bills
Subjective Ills
Unnecessary or Forced Treatments
Ignored Complaints

Chapter 7
Nature and Process of Recruitment
Potential Pool of Psychiatric Patients
Patients from Deinstitutionalization Programs
Private Health Insurance Patients
Recruitment Procedures
Professional Recruiters
Medical/Surgical Hospital Referrals
Broken Promises
Feeder Programs
Commitment Threats
Private Security
Bounty Hunting

Chapter 8
Nature and Process Retention
Retention Procedures
Exhausted Insurance Benefits
Patient Manipulation
Commitment Threats
Lack of Information
Patient Neglect or Abuse
Billing Procedures
Unauthorized Space Charges for Services Never Rendered

Chapter 9
The Privileged Vulnerable
The Chronic Mentally Ill
The Privileged Vulnerable
Temporarily Disabled
Personal Resources and Advocates
Knowledge of Complex Organizations
Knowledge to Fight Back Inside
Staff Alliances
Outside Alliances
Patients Evoked Empathy
Support from Mental Health Professionals

Chapter 10
Conclusions and Implications
Suggestions for Future Research
Name Index
Subject Index

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