When Hospitals Hurt You, Not Help You: The Horrific Treatment of Patients at One DC-Area Hospital

Kali Cyrus, MD, MPH

Disclosures

July 22, 2021

I am horrified by the American psychiatric system, and I am a psychiatrist.

Today my outrage is inspired by this report outlining the horrific treatment of patients hospitalized at the Psychiatric Institute of Washington (PIW). PIW is a hospital in the District of Columbia, where I live and practice. And I shudder to send my patients there when they are in desperate need of safety from psychiatric emergencies. However, whether it's auditory hallucinations telling them to kill their mother, unrelenting thoughts to kill themselves, or wandering around the streets naked and intoxicated, sometimes there are no other options.

Here are my takeaways from the report linked above:

  • PIW is the only for-profit hospital in Washington, DC. It is owned by Universal Health Services, which has been criticized nationally, including a civil settlement for $122 million in 2020 by the US Department of Justice.

  • PIW has had multiple complaints, which are likely underreported. Most notably, a patient who was put in a seclusion room because of "his loud snoring" laid on the floor, not breathing, not assessed, and without CPR or other lifesaving efforts for 21 minutes.

  • The hospital, the District of Columbia public health department, and the District's Department of Behavioral Health failed to adequately investigate allegations of abuse and neglect at PIW.

You are probably wondering when I will get to the point. I will — I promise.

But first I want to acknowledge that I am well aware of the privilege I hold as I critique the PIW system as an outsider. I also know that systemic problems of this degree build over time with various root causes, including, but not limited to, the dismal state of federal and state funding for emergent, outpatient, and inpatient or residential behavioral health services.

And for the record, I am not the only one who lacks faith in our mental health system. To name one of the many surveys out there about reasons people don't seek treatment for psychological problems, this one included 45,000+ respondents across 10 countries and showed that Americans felt the strongest lack of confidence in their mental health services.

Which brings me to my point: I am not the only one who recognizes that we need better mental health care in our cities, states, and nation. How many reports like this must come out before change happens? How many more patients have to be neglected, abused, or refuse to seek help because of their lack of confidence in the quality of behavioral care?

So, what are we (including any psychiatrist readers) going to do about the atrocious and horrific state of our country's mental health system? Or more important, is there anything we can do?

Each time I am confronted with the incredible shortcomings of our system, I lose part of my hope, optimism, and drive for becoming a psychiatrist in the first place. I cannot put into words how much it hurts to see people who look like you have no other options besides substandard care; where they can physically die when they should be mentally restored. This report confirmed many things I suspected, experienced myself, and heard from patients about PIW, the DC public health department, and the department of behavioral health. Yet it is still so heartbreaking to read.

I know the dread of having to tell a family friend to take their kid to PIW because I know he will not get accepted at any other hospital. I know the disappointment of sending a really sick and dangerous patient to PIW for help, only to be discharged within a day and end up in jail. I know the frustration of receiving patients discharged from week-long stints at PIW without any collaborative care phone calls from the psychiatrist, or discharge paperwork explaining what treatment transpired. I know that I am not the only person who has stories about PIW and other hospitals in my city; so do psychiatrists, case managers, and nurses across our nation. This is what keeps the little hope alive that I do have.

What do you think you can do to bring awareness or change to the atrocious and horrific parts of our country's mental health system in your area?

Will you report substandard — even if it is usual — mistreatment you see in the hospital where you work?

Will you file a complaint about substandard care at your local public health department?

Will you share your personal experiences with your department chair, hospital CEO, or health system president as encouragement for more funding to hire social workers, psychiatric prescribers, or PEERS?

Will you vote for the county, state, federal official who prioritizes expansion of healthcare and/or mental health benefits?

Will you make that phone call or send that email to another provider to investigate the questionable abuse a patient shared with you?

Will you email the local newspaper, radio station, or media source in your town to increase awareness?

Will you do more than you are already doing, whether or not the patient asks you, and whether or not the patient looks like you?

Please share any advocacy efforts you have been involved with around this issue. We need to start somewhere.

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About Dr Kali Cyrus
Kali Cyrus, MD, MPH, is a psychiatrist-activist and assistant professor at Johns Hopkins Medicine. She sees patients part-time and specializes in addressing the impact of discrimination on BIPOC and LGBTQ-identified individuals. She also offers consultation for companies and individuals on managing conflicts stemming from identity differences.
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