BEDLAM

Trenchant and lively exposÇ of the private mental-hospital business, full of attention-grabbing tales of despicable villains, chagrined confessors of misdeeds, brave whistle- blowers, and even some heroes of sorts. Names, dates, and places are all here. Investigative reporter Sharkey (Deadly Greed, 1991, etc.), his curiosity piqued and his ire raised by a brief personal encounter with a psychiatric hospital, takes a hard look at the abuses of such for-profit institutions. The provision of mental- health benefits by employers, now mandatory in many states, provided an irresistible opportunity for the psychiatric hospital business. Dominated by a few large chains with expansionist visions and aggressive marketing techniques, the industry boomed in the late 1980's, with the number of psychiatric hospitals more than doubling between 1984 and 1989. High-pressure advertising encouraged inpatient mental-health treatment for ordinary adolescent behavioral problems and run-of-the-mill emotional difficulties. Competition for patients with insurance coverage led to payoffs to clergy, family counselors, ans school and hospital officials; bonuses for psychiatrists willing to come up with appropriate diagnoses; misleading use of crisis hotline phone numbers; and even abduction of potential patients. Sharkey, who writes with a practiced reporter's directness, concentrates on marketing abuses, but he also gives a glimpse of common practices inside treatment centers: overmedication; therapy resembling punishment more than treatment; and discharge dates pegged to insurance expiration dates. The industry has promised reforms, but Sharkey notes that the basic problem remains: how to provide proper mental-health care in an atmosphere of profit incentives. An impossible-to-ignore alarm about one segment of the medical-industrial complex, timed perfectly for the year's big health care debate.