Mental Health Inc

by Art Levine

  Out of all the federal and state inaction came a chance to grow a thriving business for CRC. Where some see neglect and dangerously lax regulation, others see investment opportunities. In California, although fraud by inpatient rehab clinics has finally garnered statewide attention, the regulation of outpatient drug treatment facilities still appears especially ineffective. Yet what’s not widely known is that the now-closed California Department of Alcohol and Drug Programs (ADP), for example, had never investigated the deaths of nearly two hundred patients over five years at CRC’s dozen or so outpatient methadone clinics in the state. Remarkably, those deaths, followed by over three hundred fatalities annually in all of the state-approved methadone programs, still remain unexplored by the broader state health department that took over ADP’s role, the DHCS. (A spokesperson for the department declined to answer questions or offer any examples of any government response to the wave of methadone clinic deaths.)

  Mostly likely, addiction experts say, the clients’ rampant substance abuse is the culprit, not sloppy practices at CRC or other clinics, but that supposition has not been rigorously tested. In fact, in 2011 Pennsylvania regulators cited two of CRC’s methadone clinics for failing to properly screen patients for drugs or narcotics use, a potentially deadly oversight.

  In subsequent years, more problems with CRC’s methadone clinics—many of whose patients suffered from serious mental illnesses as well—were revealed whenever state agencies bothered to look. There are over eighty methadone clinics nationwide owned by CRC, and the upsurge in opiate addiction is surely good for business. Yet by 2013 and even earlier, according to Bloomberg News and other media outlets, law enforcement officials and state regulators in Virginia, West Virginia, Indiana, Maryland and other states uncovered a disturbing trend: CRC clinics were allegedly involved in loosely regulated take-home methadone practices that may have played a role in deaths and illegal drug-dealing. In response, a spokesperson for CRC said it had many safeguards against misuse, including screening people for take-home privileges and the use of lockboxes for their home supplies of the drug.

  Yet there’s little sign that CRC subsequently actually took a tough-minded, fresh look at their methadone clinics’ practices. And in states like California, patient protections were eased up further: California regulators and law enforcement agencies haven’t sought to look closely at why so many CRC methadone patients are dying, let alone explore the trends in illegal methadone use nearby where CRC clinics are located. At the same time, as reported by the World Health Organization and the Institute of Medicine, methadone, along with the drug Suboxone, has real treatment value when properly distributed and monitored: it can significantly reduce illegal drug use, and this “medication-assisted treatment” also lowers overdose mortality by 75 percent, as noted in Maia Szalavitz’s recent book, Unbroken Brain. Due to what amounts to criminally negligent regulation in California, however, “The programs have experienced the reality that there are no consequences if anyone dies,” says a knowledgeable former California rehab regulator about the state’s drug programs. These include CRC’s methadone clinics, which have become the chain’s cash cow.

  • • •

  THE LOOSE OVERSIGHT SEEMS TO HAVE BEEN CRITICAL IN ENABLING CRC to flourish. It’s hard to imagine, in particular, that without the scandalously weak monitoring of the teen treatment industry, CRC’s Aspen division would have been able to continue its harshly regimented, unproven behavior-modification methods and dicey emergency protocols.

  This apparent lack of oversight in the teen industry, combined with a widespread view by providers that their charges are manipulative troublemakers, has allowed a toxic culture of psychological abuse and medical neglect to prevail, according to parents, alumni and federal officials. That culture was visible even at Aspen Education’s most upscale residential programs, such as Island View in suburban Syracuse, Utah. One former student there, Colleen Davidson, now twenty-four, who graduated from the program in 2009, recalls her alarm when she coughed up blood one morning as she stood at the bathroom sink. She says she was never allowed to see a doctor because, by the time the nurse wandered by a few hours later, another student had rinsed the blood from the sink. “They assume you’re lying,” she says.

  For months, CRC denied me press access to any of its facilities, so I visited Island View in 2012, posing as a father of a troubled girl. During that visit, director Laura Burt confirmed this skeptical stance towards potential medical emergencies. She said the nursing staff would see my (fictitious) daughter immediately in case of a medical crisis but would monitor her if they suspected fakery: “We’re not going to rush her to the hospital if she’s just saying that and there is nothing that says it.”

  These incidents seem to illuminate an institutional culture that allowed Sergey Blashchishen to die in 2009 before ever receiving emergency medical aid. As one government investigator told me about the field instructors at SageWalk, where Blashchishen died, “They were highly trained, but the culture overrode that.” The SageWalk Field Instructor Manual—like other Aspen manuals that were vetted by CRC, according to a former CRC official—requires staff to go through a rigid “chain of command” before emergency help can be summoned.

  CRC spokespeople, including Weiner, insisted that safety is a top priority and there are no major problems. They pointed to a recent initiative by CRC to ensure that all its teen programs are certified by two leading accrediting agencies, the Commission on Accreditation of Rehabilitation Facilities (CARF) and a body known as the Joint Commission, a sixty-year-old industry-funded nonprofit that accredits thousands of health-care programs in the United States.

  This offers scant comfort, given that members of Congress harshly criticized the Joint Commission in the wake of revelations of medical negligence at Walter Reed and other Joint Commission–accredited hospitals. Moreover, many facilities in one of the most notorious chains in the teen treatment field, Mel Sembler’s Straight Inc., were approved by accrediting agencies, including the Joint Commission, until they shut down in the wake of lawsuits and state action. Some maintained their high ratings even after Straight Inc. and several of its spin-offs were hit by state investigations and as many as ninety lawsuits alleging abuse.

  • • •

  DESPITE THE ACCUMULATING LAWSUITS, STATE INVESTIGATIONS AND EVEN criminal inquiries, neither Bain Capital nor Acadia forced any major shake-ups in the culture or leadership of CRC when the company was acquired. Aspen co-founder Elliot Sainer and CRC CEO Barry Karlin remained in their executive posts until they retired in 2007 and 2010, respectively. Trina Packard, the executive in charge at Youth Care when Brendan Blum died, remains in her post.

  Rather than instituting reforms, CRC seems to have responded to the series of lawsuits, in part, by requiring parents to sign elaborate contracts that feature sweeping “hold harmless” clauses even in the case of death.

  Aspen Education, now down to just four treatment facilities, uses what the teen treatment industry calls a “levels” model that grants more privileges and freedoms as students follow the rules, but imposes varying degrees of humiliation and harsh sanctions on those who slip up or disobey. Punishments were more often psychological than physical at Aspen programs. According to former students, emotionally brutal isolation punishments and peer-driven encounter “therapies” were commonly employed to break down resistance, especially at Island View. These concerns about Island View’s prisonlike environment were also raised in two lawsuits filed in early 2014 by ex-students. Both lawsuits were ultimately dismissed on technical grounds, one for being filed after the statute of limitation.

  As is all too common in the troubled-teen field, Seroquel and other antipsychotics were part of the behavioral control arsenal used on teens at Island View, according to a disturbing investigative article in The Huffington Post in August 2016. Regardless of FDA rules, the teenagers at Island View were swamped with off-label antipsychotics. Emily Graeber, then a fifteen-year-old who ran away from Island
View and was sent back by her parents, received the maximum dosage of Seroquel approved for adults: 800 mg. “I feel like they kept us sedated for ease of control so people wouldn’t have as many outbursts,” Graeber, now twenty-three, told The Huffington Post, a charge denied in the article by a former Island View administrator.

  Shortly after the 2014 lawsuits were filed, Aspen Education closed down Island View, but it reopened with a new name, Elevations, under a new company, Family Help and Wellness, headed by a former Aspen Education executive—and with the same tough-love philosophy. Nearly 80 percent of its employees are the same. Apparently, not much has changed at Elevations in terms of Aspen-style practices, according to the Huffington Post investigation. In addition to the ongoing use of off-label antipsychotics, the article by Sebastian Murdock revealed, “Staff are still isolating and physically restraining children. At least one has attempted suicide. Others have tried to run away.” (A spokesperson for Elevations denied in The Huffington Post any cruel or improper treatment of kids, claimed all therapies are accepted by the state, and said that the four-by-four isolation cells cited by Murdock were just “time-out rooms” because the doors were unlocked.)

  Yet if the same therapeutic approaches that operated at Island View have continued at Elevations, kids may be in further danger. The confrontational sessions at Island View were so terrifying that girls resorted to desperate measures to avoid attending, according to Colleen Davidson. She recalls that some girls choked themselves to induce fainting; one rubbed feces in her own eyes to cause an infection.

  “They break you down, but they don’t really build you back up,” she says of the Island View approach, still widely emulated in other teen programs. “I have nightmares from it, and the memories are really awful.”

  • • •

  CRC DECLINED TO ADDRESS ANY PROGRAM-SPECIFIC ALLEGATIONS WHEN I researched the company in 2012, and spokespeople for the new owner, Acadia, have since declined to reply to any of my phoned questions.

  Short of rigorous evidence that their programs work, CRC’s PR machine offered up testimonials from pleased parents and CRC-funded surveys of parents and students that report positive outcomes. CRC’s spokesperson at the time, Kristen Hayes, put me in touch with one of these parents, the mother of a self-destructive, drug-abusing fifteen-year-old son whom she sent to Island View, the Aspen program Colleen Davidson attended, after other treatments had failed. “I didn’t want to stand around and wait for my child to die,” she said bluntly. Enrolling him in Aspen, she said, was the turning point. “I wish all kids were as lucky as my son,” she observed.

  And what can’t be washed away by good PR can always be described as an unavoidable tragedy. At Youth Care of Utah, admissions counselor Claire Roberts offered up this sort of soft-focus gloss when she told me about the death of Brendan Blum. “It was very traumatizing for us,” she said. Then she added philosophically, “These things happen.”

  Surprisingly, by 2016, there were small, hopeful signs of change. These include a new state oversight law in Washington lobbied for by HEAL. Most significantly, in September 2016 California passed a law—then among the toughest in the country—requiring the licensing and monitoring of troubled-teen sites, including religious schools. The California law passed largely because of a brilliant, media-savvy alliance between an older generation of victims who were members of the Survivors of Institutional Abuse (SIA), and the politically influential Los Angeles LGBT Center, which was outraged by the troubled-teen industry’s efforts to harm gay teens while claiming to “cure” their sexual or gender identity. But it was not certain that these new laws would be any better enforced than regulation of drug treatment programs in California or youth programs in Utah. Still, Jodi Hobbs, the president of SIA, while praising the California law, struck a forceful note after it passed. “It’s not enough,” she said. “Until we finally pass federal legislation to regulate this rogue industry in every state, the lives and well-being of youth remain at risk.” SIA estimates that over the years as many as three hundred kids have died in these programs or killed themselves afterward.

  Indeed, the states, once called the “laboratories of democracy,” have proved to be in this regard experiments in failure and death. In most states, government inaction that allows the death, neglect, abuse and rape of young people to continue remained the rule, not the exception. Perhaps no state in the country, with the possible exception of Utah, illustrated just how dangerous all these factors could be as much as Florida. There, government and law enforcement agencies often looked the other way as literally hundreds of emotionally troubled kids were abused, raped and killed.

  CHAPTER 14

  Florida: Free-Fire Zone for Killing, Abusing and Raping Kids?

  SHORTLY AFTER 8:30 P.M. ON MARCH 3, 2011, SIXTEEN-YEAR-OLD Susan Jackson returned to the Vanguard School in Lake Wales, Florida, after a trip to Starbucks with a classmate. The girls’ dorm monitor, Kami Land, had driven them in her car to the coffee shop and then dropped them off near Boyd Hall, their dorm at the center of campus. They were supposed to be in bed soon.

  Curfew at the private Florida boarding school for kids with learning disabilities was 10 p.m. In Susan’s case, however, the campus had imposed a 9:30 p.m. curfew on her in January 2011, after she had been hospitalized after smoking methamphetamine-laced marijuana that she and a friend had bought off-campus.

  Instead of heading to her room, however, Susan walked away from the main cluster of buildings and towards the gym, the athletic field and the woods that ringed a lake on the south end of campus, which is just south of Orlando. During the day, students played tennis, soccer, golf and paintball on the grounds or canoed on the pristine water. At night, however, the campus’s remote areas became popular spots for students looking to hook up or do drugs.

  Therefore, they were off-limits to Susan unless a staff member accompanied her. When Susan failed to return by her curfew, a security guard went looking for her. He eventually found her—distraught, frightened and disoriented—behind the school’s greenhouse near the woods.

  “She was upset and very scared,” recalled Ellen, a student who lived across the hall from Susan. “Her hair was messed up. She had mascara on her face, and it was obvious that she had been crying.”

  “I asked her, I said, ‘Are you OK?’ And she said, ‘I was raped.’”

  The details gradually emerged that night and the next day. (For confidentiality reasons, I’m withholding the real names of all juveniles in this chapter.) Two male students I’ll call William and David had tricked Susan into walking with them into the woods on school grounds, the sixteen-year-old girl reported. Then they forced her to her knees and made her give one of them, William, oral sex. The night of the alleged attack, after she had returned to her dorm’s kitchen, Susan told her dorm monitor, Kami Land, what had happened.

  Nobody working at the school—or in local law enforcement or at the state Department of Children and Families (DCF)—adequately followed up on claims by Susan or several other victims of similar alleged crimes at Vanguard. For instance, Det. Mary Jerome of the Lake Wales Police Department allowed the school’s president to help in questioning the suspects and suggesting alibis, which is not an accepted practice. And cops closed the case the same day the rape was reported without obtaining any evidence supporting the suspects’ alibis, according to legal and police documents filed in the case.

  Perhaps just as alarming, I reviewed a twenty-one-page list of 911 calls from the Vanguard School to the county’s emergency call center between November 2010 and September 2014, plus a list of the far fewer service calls and even fewer arrests by Lake Wales cops. They indicate dozens of phoned-in emergencies, including at least a dozen assault cases and other violent disturbances—and some attempted suicides.

  It also seems incidents are sometimes neither reported nor logged. For instance, on January 17, 2013, according to former teacher Gail Bonnichsen, a teenage girl was allegedly assaulted on the grounds by a student who jamme
d his hand inside her, causing vaginal bleeding. But staff on duty that night brushed aside the girl’s concerns and didn’t call police or seek medical help—until the girl told Bonnichsen about it late the next day. Bonnichsen claims she called a DCF abuse hotline and two local police departments, but the agencies never responded. “Nothing was done about it, and nobody gave a crap,” Bonnichsen says.

  Vanguard caters primarily to children and teens with learning disabilities who may also have developmental problems. But over time, it has increasingly become a haven—or “dumping ground,” as one disgruntled parent calls it—generally for affluent disturbed and violent youths. Even so, Vanguard’s website promises that its “safe, supportive environment facilitates physical, social, and emotional growth of all students” and that its “dormitories are a home-away-from-home for [its] residential students.”

  In a 2011 reply to a lawsuit filed by Susan’s family, the school’s attorneys denied negligence. Despite repeated email and phone inquiries from me, school officials declined to answer any broader questions about student safety and the alleged failure to properly report crimes. Polk County-based attorney Richard Straughn, who represents the school, wrote me, “The health, safety, and well-being of students are top priorities at the Vanguard School … Part of our commitment includes complete respect for the confidentiality and privacy rights of our students and families.”

  The allegations of trouble at Vanguard embody a pattern of regulatory failure common across the entire field of troubled and disabled teen programs. Private schools and residential programs for youngsters, as noted in earlier chapters, not only house kids with learning disabilities but also with emotional, behavioral and addiction problems. Vanguard, though, doesn’t employ the notorious tough-love approach common in many other teen residential programs. Vanguard isn’t the worst program in the country, but in the absence of any state or federal agency reliably tracking deaths and abuse, there is no way of knowing which residential program is in fact the most deadly.