CCHR says a recent Journal of Legislation article finds steps taken by 11 states and Congress are inadequate given the “sheer urgency” to curb abuse, neglect, injury and death occurring at residential behavioral treatment facilities
By Jan Eastgate
President CCHR International
Mental Health Industry Watchdog
May 31, 2024
A recent paper published in The Journal of Legislation about the need for greater oversight of the “troubled teen” behavioral industry conveys how “there has never been a more opportune (and critical) time to regulate and reform the troubled teen industry.”[1] CCHR, which has been exposing abuse of children and teens in residential psychiatric hospitals and behavioral programs such as “wilderness” and “boot” camps for more than 30 years, welcomes the analysis of legislative needs. It agrees with the recommendations the paper highlights on the urgency for reform. Morgan Rubino, a J.D. Candidate, at the Notre Dame Law School in Indiana, concluded in his paper, “The concerning number of abuse and neglect allegations and rising reports of injury and death occurring at residential treatment facilities reflect the sheer urgency.”
That urgency will likely be addressed in a hearing being held in June by the U.S. Senate Finance Committee. Since 2022, it has been investigating teen and youth abuses in behavioral hospital chains owned by Universal Health Services, Acadia Healthcare, Deveraux Advanced Behavioral Health, and Vivant Healthcare (aka Sequel Youth and Family Services).[2]
Paris Hilton, who has been passionately campaigning for reform in this area, has urged victims of abuse in these facilities to testify. Anyone who has been abused in one of the four behavioral hospital chains can sign up to provide testimony here.
In 2015, CCHR began increasing its efforts to expose psychiatric and psychological abuse in these facilities, alerting all state and federal legislators about the lack of oversight and accountability that has contributed to patient suicides, restraint deaths, and patients being sexually assaulted, especially in for-profit behavioral and state-run hospitals.[3] The issue came to national attention in 2020, following the death of 16-year-old Cornelius Frederick, an African American foster care youth, from a restraint at the now-closed Lakeside Academy, a residential behavioral facility for teens, in Michigan. The Kalamazoo County Medical Examiner’s office determined Frederick’s cause of death was a homicide and three staff were charged with involuntary manslaughter and second-degree child abuse—all pleading guilty.[4]
Several months later, Paris Hilton spoke publicly for the first time about being sent as a teen to Provo Canyon behavioral facility in Utah where she was abused.[5] This ignited a firestorm of media and public awareness. CCHR launched a website page on the number of child restraint deaths and abuse at the behavioral hospital chain owned by Universal Health Services, which bought out Provo Canyon after Hilton had left the facility.[6]
Rubino points to Hilton’s diligent work and details: “The use of restraints and seclusion can cause serious physical and psychological trauma to minors, and there is ‘no evidence that using restraint or seclusion is effective in reducing the occurrence of the problem behaviors that frequently precipitate the use of such techniques.’ That is why, as some states have started doing, the use of restraints and seclusion as discipline should have to be reported and documented, and eventually outlawed.”[7]
He continues: “Drugs are also administered as a restraint to manage behavior and temporarily restrict freedom of movement. Reports indicate that residential facilities severely overmedicate residents, often with antipsychotics and sedatives….” Residents in the programs have alleged staff also “placed them in solitary confinement for long periods of time, ranging from days to weeks, as punishment for bad behavior.”[8]
CCHR acknowledges the importance of the groundswell of media and other coverage on the need to eliminate coercive and abusive psychiatric practices.
In January 2024, Psychiatric Services published a study, “Toward the Cessation of Seclusion and Mechanical Restraint Use in Psychiatric Hospitals: A Call for Regulatory Action,” in which the authors emphasized “the importance of external regulatory oversight and mandates to safely achieve and sustain the cessation of S-R [seclusion-restraint] use in psychiatric hospitals.” They urged the Center for Medicaid and Medicare (CMS) and The Joint Commission (TJC) to update their regulations, to more effectively mandate the reduction and eventual cessation of seclusion and restraint use in psychiatric hospitals. [9]
The American Bar Association estimated that between 120,000–200,000 young people reside in some type of group home, residential behavioral treatment centers, boot camps, or correctional facilities, which is a lucrative $23 billion a year industry. [10]
Some states have started to enact regulations toward enforcing patient protections in behavioral, psychiatric or “troubled teen” programs:
Montana: A 2019 state law created new regulations for programs and moved oversight. A month after the health department took over oversight of the programs, the state removed 27 children from a specific program and revoked its license. By late 2020, 11 of Montana’s 19 programs had closed.[11] In May 2023, Montana amended its law and banned the threat or use of physical discipline “as punishment, deterrent, or incentive,” and requires programs to report the use of any restraints within one business day. It also increased the frequency of inspections.[12]
Michigan: In response to the death of 16-year-old Cornelius Frederic from a restraint, in July 2020, the Michigan Department of Health and Human Services banned the use of dangerous restraints similar to that used on the teen. The department prohibited the use of prone restraints, or pinning a child face-down, as well as any other restraint that restricts a child’s breathing.[13]
Ohio: In December 2020, Rule 5122-2-17 “Seclusion and restraint use in regional psychiatric hospitals” was passed detailing that treatment environments needed to be free of coercive interventions and violence. Staff cannot employ a drug to restrict or manage a patient’s behavior and restraints cannot be used as coercion, discipline, or punishment; or for the convenience of staff.[14]
Utah: On March 21, 2021, Utah passed S.B. 127 requiring residential treatment centers to no longer engage in any “cruel, severe, unusual, or unnecessary” practices, including discipline designed to frighten or humiliate, physical restraints, or seclusion, without a showing of absolute necessity or direct authorization. Further, the law requires them to report to the Utah Office of Licensing the use “of a restraint or seclusion within one business day after the day on which the use of the restraint or seclusion occurs,” as well as “a critical incident within one business day after the day on which the incident occurs.”[15]
Missouri: On July 14, 2021, two bills were enacted. One was in response to girls alleging being hit, restrained and sexually abused in an unlicensed behavioral facility, Circle of Hope Girls Ranch, and brought such facilities under state oversight. Under one, all employees must submit fingerprints and undergo stringent background checks. Further, the law allows a number of individuals and agencies to petition the court to remove a child they believe to have been abused or neglected inside a residential care facility. [16]
Oregon: In July 2021, S.B. 749 was enacted where “referral agents” to a behavioral program must disclose “[t]he number of substantiated allegations of abuse, deaths and serious injuries at the program in the prior [24] months.” On August 5, 2021, Oregon also enacted S.B. 710, restricting restraint use, permitting it only where patient behavior “poses a reasonable risk of imminent serious bodily injury” to themselves.[17]
Illinois: In June 2023, a law was passed that enforces “workers to be barred from health care jobs for obstructing” investigations into hospital abuse. It strengthens the range of penalties that a state watchdog can impose on healthcare employees who conspire to hide abuse or interfere with investigations by the state police or internal oversight bodies. This stemmed from a Capitol News and Pro Publica investigation into rampant abuses and cover-ups at Choate Mental Health and Developmental Center, a state-run institution.[18]
Indiana: On March 13, 2024, a law was signed to increase scrutiny of care and to curb abuse in residential behavioral facilities. It authorizes the Department of Child Services to investigate claims of sexual abuse involving patients ages 18 to 21.[19] This was because staff did not consider them “minors” and, therefore, sexual relations with them was not a crime. The state code was amended to define this age group under state care to be minors and abusers subject to investigation and criminal prosecution.[20]
In 2024, bills were also introduced in New Hampshire[21], Alaska[22] and California.[23]
The passage of the Stop Institutional Child Abuse Act, introduced into Congress last year, is a vital first step towards regulating the troubled teen behavioral treatment industry. The bill, introduced by Rep. Ro Khanna is supported by Hilton and many groups, including CCHR International.[24]
Ultimately, CCHR wants to see all coercive psychiatric practices prohibited in alignment with the World Health Organization and United Nations guidance on “Mental Health, Human Rights and Legislation.”
References
References:
2024
CCHR Recaps Mental Health Awareness Month: The Silent Epidemic of Patient Abuse Cover-Ups
CCHR Rebukes Psychiatric Association Meeting for Failure to Denounce Coercion
Mental Health Awareness Month: Watchdog Blasts Ongoing Psychiatric Racism
CCHR Praises State Governments Acting to Curb Restraint Use in Psych Facilities
Forced into a Psych Ward: Know Your Rights Against Coercive Psychiatry
CCHR Demands Stronger Accountability in Troubled Teen Behavioral Industry
2023
Study Finds 141% Increase in Psychotropic Drug Restraints of Children
CCHR Reissues Call for Ban on Psychiatric Restraints Amid Global Concerns
Mother Jones Story on Behavioral Facility Abuse of Foster Children Applauded
Before Oct. 2023
New WHO Mental Health Guideline Condemns Coercive Psychiatric Practices
For-Profit Psychiatric Hospitals Need Stronger Penalties for Abuses and Deaths
Tragic Deaths Reveal Shocking Pattern of Abuse in Troubled Teen Industry
CCHR Urges Mental Health Awareness Month Focus on Prevention of Widespread Abuse Within the Industry
CCHR Calls for Oversight of Troubled Teen Industry Due to Systemic Abuse
Mental Health Funding Has Delivered Deaths, Child Abuse, and a System in Shambles
Oversight of Chemical Restraint Use in Foster Care Children Has Failed and Harmed Them
Involuntary Commitment and Forced Mental Health Treatment Violate Human Rights
2022
New Year Needs to Ring in the End of Coercive Psychiatric Practices
CCHR Reviews a Year of Child Abuse Allegations Against Troubled Teen Behavioral Institutions
CCHR Issues Resolution to Replace Forced Psychiatric Treatment and Torture with Human Rights
Human Rights Laws Needed to End Coercive Psychiatric Practices Against African Americans
U.S. Could Learn from Reform of Coercive Mental Health Practices
Mental Illness Awareness Week—Another Psychiatric Restraint, Another Child Death
CCHR Encourages Support for Paris Hilton & Congressional Child Abuse Reforms
CCHR Launches Mental Health Rights Policy to Prevent Patient Torture
2021
CCHR International: Clearinghouse of Mental Health Information Offers Resources
CCHR Thankful for Media Attention Given to Abuses in Child Mental Health System
Mental Health Abuse Reforms Aim to Protect Against Behavioral Abuse of Children
CCHR Welcomes State Actions that Ban or Restrict Behavioral Restraint Use
UN Special Rapporteur Dainius Pūras Addresses Psychiatry’s Global Coercion & Crisis
CCHR: Laws Inadequate to Safeguard Troubled Teens from Psychiatric Abuse
CCHR Supports WHO Recommendations for Psychiatric Living Wills to Prevent Abuse
World Health Organization New Guidelines are Vital to End Coercive Psychiatric Practices & Abuse
CCHR Supports Congress Members Wanting Youth Behavioral Centers Investigated
New Year Starts with Continuing Child Abuse and Deaths in For-Profit Psychiatric Facilities
Troubled Teens Targeted for Risky “Behavioral” Treatment
2020
More Media Urged to Expose Youth Behavioral “Houses of Horror” & “Death traps”
Half a Million Americans Want Two Behavioral Hospital Chains Closed Over Teen Abuse
CCHR: Bipartisan Action Needed to Stop Child Torture in Behavioral Facilities
CCHR Urges Overhaul of Teen Behavioral Industry: 30 Years of Children at Risk
Paris Hilton Speaks Out About “Behavior Modification” Abuse of Teens
Child Abuse Allegations in the Behavioral-Psychiatric Industry: Universal Health Services (UHS)
UHS—For-Profit Psych Hospital’s $132 Million Payout Over DOJ & MA Fraud Investigations
Another For-Profit Scandalized Psychiatric Hospital—Montevista in Las Vegas—Closes
Colorado Restraint & Drug Death Should Be Investigated for Racism Link CCHR Says
The Risky Business of Foster Youth Drugged in For-Profit Behavioral Hospitals
CCHR Applauds State Acting on African American Teen Psychiatric Restraint Death
NAACP Inglewood-South Bay Executive and CCHR Call for Restraints Ban in Psychiatric Hospitals
School Seclusion & Restraint Ban Should Extend to Psychiatric Facilities
2019
A-Z Update on For-Profit Psychiatric Industry Abuse
Psychiatric For-Profit Hospitals—Rife with Fraud, Patient Abuse, Rape, and Suicide
2018
Drugging and Restraint Use on Migrant Children
Largest Psych Hospital Chain Loses Another Facility Over Abuse & Violence
2017
2016
CCHR Calls for Legislative Intervention Against For-Profit Psych Facility Planned for Pennsylvania
Florida Psych Facility To Close Amidst Patient Abuse Allegations
2015
Sample Restraint & Seclusion Law Language
[1] Morgan Rubino, “More than Troubling: The Alarming Absence of ‘Troubled Teen Industry’ Regulation and Proposals for Reform,” The Journal of Legislation, 2024, p. 455, https://scholarship.law.nd.edu/jleg/vol50/iss2/6/
[2] https://www.help.senate.gov/chair/newsroom/press/murray-wyden-demand-answers-on-mistreatment-at-youth-residential-treatment-facilities
[3] “Sexual Assault of Patients, Restraint Deaths, Billing Fraud… Allegations Against National Psychiatric Hospital Chain Continue,” CCHR Int., 17 Nov. 2015, https://www.cchrint.org/2015/11/18/allegations-against-psych-hospital-chain-continue/
[4] https://www.cchrint.org/2020/10/05/paris-hilton-speaks-out-about-behavior-modification-abuse-of-teens/
[5] https://www.cchrint.org/2020/10/05/paris-hilton-speaks-out-about-behavior-modification-abuse-of-teens/
[6] “Child Abuse Allegations in the Behavioral-Psychiatric Industry: Universal Health Services (UHS),” CCHR Int., 30 Oct. 2020, https://www.cchrint.org/2020/10/30/child-abuse-allegations-in-the-behavioral-psychiatric-industry-universal-health-services-uhs
[7] Op. cit., Rubino, p. 449
[8] Op. cit., Rubino, p. 449
[9] S Atdjian, K A Huckshorn, “Toward the Cessation of Seclusion and Mechanical Restraint Use in Psychiatric Hospitals: A Call for Regulatory Action,” Psychiatric Services, Jan. 2024, https://pubmed.ncbi.nlm.nih.gov/37461820/
[10] https://www.americanbar.org/groups/litigation/resources/newsletters/childrens-rights/five-facts-about-troubled-teen-industry/?login
[11] https://kffhealthnews.org/news/article/state-laws-aim-to-regulate-troubled-teen-industry-but-loopholes-remain/
[12] Op. cit., Rubino, p. 441
[13] Angie Jackson and Dave Boucher, “Michigan bans using dangerous restraints on children at youth centers after teen’s death,” Detroit Free Press, https://www.freep.com/story/news/local/michigan/2020/07/16/ban-dangerous-restraints-youth-centers-cornelius-fredericks/5450551002/
[14] Ohio Laws & Administrative Rules, Rule 5122-2-17 | Seclusion and restraint use in regional psychiatric hospitals, 3 Dec. 2020, https://codes.ohio.gov/ohio-administrative-code/rule-5122-2-17#:~:text=(1)%20RPH%20policies%20for%20seclusion,discontinued%20at%20the%20earliest%20possible
[15] Op. cit., Rubino, pp. 441-442
[16] Op. cit., Rubino, p. 442
[17] Ibid., pp. 442-443
[18] “Health care workers who cover up patient abuse face stiffer penalties under new law,” Capitol News, 12 June 2023, https://capitolnewsillinois.com/INVESTIGATIONS/health-care-workers-who-cover-up-patient-abuse-face-stiffer-penalties-under-new-law
[19] Tony Cook, “Indiana Enacts Law to Allow State Child Services to Investigate More Abuse Claims at Youth Centers: Indiana Gov. Eric Holcomb signed a bill into law that aims to curb abuse at youth treatment centers for those 18-21 years old. It comes after a ProPublica-IndyStar investigation into employees at Pierceton Woods Academy,” ProPublica, co-published with Indy Star, 15 Mar. 2024, https://www.propublica.org/article/indiana-law-abuse-youth-treatment-centers; “Op-ed: Garcia Wilburn: This Child Abuse Prevention Month, I’m calling for accountability for the residential care facility industry,” Indiana House Democratic Caucus, https://indianahousedemocrats.org/news-media/op-ed-garcia-wilburn-this-child-abuse-prevention-month-im-calling-for-accountability-for-the-residential-care-facility-industry
[20] Ibid.
[21] “Paris Hilton supports NH Senate bill ‘to protect youth’ after trauma of her childhood,” Seacoastline, 21 Mar. 2024, https://www.seacoastonline.com/story/news/state/2024/03/21/paris-hilton-supports-nh-senate-bill-417-protect-youth/73052744007/; https://www.gencourt.state.nh.us/bill_Status/billinfo.aspx?id=2067&inflect=2
[22] Michelle Theriault Boots, “2 bills seek reform of Alaska’s youth psychiatric residential treatment system,” Anchorage Daily News, 14 March 2024, https://www.adn.com/politics/alaska-legislature/2024/03/14/two-bills-seek-reform-of-alaskas-youth-psychiatric-residential-treatment-system/
[23] Tran Nguyen, “Paris Hilton backs California bill to bring more transparency to youth treatment facilities,” NBC Bay Area, 15 Apr. 2024, https://www.nbcbayarea.com/entertainment/entertainment-news/paris-hilton-backs-california-bill-to-bring-more-transparency-to-youth-treatment-facilities/3511033/
[24] Op. Cit., Rubino, p. 451; https://thehill.com/blogs/in-the-know/3976271-paris-hilton-pushes-bipartisan-bill-to-reform-troubled-teen-industry/
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