Top reporters on opposite coasts dug into psychiatric hospitals in 2019. Here’s what they learned.

Investigative reporter Daniel Gilbert of The Seattle Times didn’t set out to write about private psychiatric hospitals in 2019. But when he learned that companies were competing to open facilities across Washington state — and actively blocking each other’s projects — he wanted to learn more. Experts had told Gilbert there was no money in mental health. What he was seeing on the ground, however, suggested the opposite was true.

Gilbert started digging. He soon realized the industry’s rapid expansion — driven by increasing need and lacking capacity — in Washington had come at a cost. His blockbuster series, “Public Crisis, Private Toll,” unearthed serious safety problems at psychiatric hospitals across the state and showed how regulators had repeatedly failed to address issues. He also documented dubious business practices at some of the hospitals, including efforts to keep patients from leaving.

On the other side of the country, Tampa Bay Times investigative reporter Neil Bedi was onto a similar story. Bedi had received back-to-back calls from people who said their relatives were trapped inside a private psychiatric hospital near Tampa. Florida law allows some facilities to keep people for up to 72 hours for involuntary mental health evaluations. But the callers said 72 hours had come and gone and they still couldn’t get their relatives out.

Bedi was able to show how the hospital had used loopholes in state law to prevent patients from leaving — and managed to become one of the most profitable psychiatric hospitals in Florida. He also chronicled a history of safety problems at the facility. (Full disclosure: I edited the story.) 

I got the two reporters on the phone in November to discuss their respective projects and what they learned about reporting on private psychiatric hospitals. Our conversation, below, was edited for clarity and length.

Daniel, you started off spotting a trend and wanting to know more. How did you move from that broad idea to the sharp, narrow investigation you ultimately produced?

Daniel Gilbert: I had already started looking into (the proliferation of private psychiatric hospitals) and there was a tip that came in about one hospital in particular. I thought, let me see what I could learn about that hospital. It turned out to be one of these private hospitals that had opened recently. I started pulling on that thread.

The number of private psychiatric hospitals in Washington is relatively small. It seemed like a manageable number to request some records on and to try to get a sense of what some of the issues were.

Which records did you seek out? 

DG: There were a couple of records that regulators have that I found key to understanding what was going on. One is the complaints to the Department of Health which licenses these hospitals. I was seeing complaints from former patients, from current and former employees, from government officials who would go into the hospital or have occasion to seek out a patient there. The diversity got my attention. I was thinking, well, if (people with) this many different types of perspectives are identifying a problem, that is something I want to understand better.

There’s also what the regulator does about it, be it the state agency or the Centers for Medicare and Medicaid Services. Whenever they issue a statement of deficiencies, that is a kind of a confirmation of, “Yes, in fact, this complaint was substantiated.” It’s not perfect. Just because they don’t issue a statement of deficiencies doesn’t mean there was no problem there. But those were a good guide about the frequency with which inspectors were finding those problems and also the severity of those problems.

Neil, did you rely on those same types of records?

NB: We did the typical backgrounding of hospitals where you go through all their inspection reports, all of their complaints. We then also requested any calls for service or police reports at the hospital address because it turns out that these facilities tend to get a lot of calls for service, especially if they have safety problems. We were able to pull a lot of great details from those police reports.

The other interesting thing was, because a lot of the involuntary commitment process is done in the courts in Florida, we were able to pull court data and show how the hospital we reported on was different compared to the other behavioral health facilities nearby. (Editor’s note: In Florida, judges can initiate an involuntary commitment and must weigh in when a hospital wants to keep someone longer than 72 hours.)

Did either of you find that patients and their families were reluctant to tell their stories given the stigma around mental health?

NB: This may have been one of the most difficult stories I’ve been on to get patients and their families on the record. It was usually not the families, but the patients themselves who struggled with the idea of associating their names publicly with their mental illness. A lot of times, they were dealing with a serious crisis and they had gotten past that. They really didn’t want to backtrack. I talked to many patients (for this story) but only a fraction of them were willing to go on the record.

How were you able to convince some of them to go on the record?

NB: I wasn’t really pushing them. I was talking it through with them. These same patients believed they were treated poorly and wrongly and they thought that there were serious problems here. I tried to explain how, in some ways, (talking to a reporter) is empowering and helps give a voice to the many other patients I might not be speaking to.

Daniel, what was the experience like for you?

DG: When I first started reporting on this, I hadn’t really done a lot of health care reporting. I hadn’t done a lot of mental health reporting, either. So I reached out to someone I know who is very experienced: Meg Kissinger from the Milwaukee Journal Sentinel (now at Columbia University), whose work on mental health care I really admire. I just asked for her advice. Meg encouraged me to seek out patient voices that, in her experience, you don’t always hear, including those who had been hospitalized for mental illness. And I found a good number of people who just seemed to be happy that someone was listening.

One of the things I thought about was, with these patients I’m talking to, what should I do to make sure they are going to be comfortable with this in the long run? I wanted people to talk on the record, but I also wanted them to feel good about their decision. I followed up with everyone I talked to and so far, people felt OK about their decisions. I’m grateful to everyone who spoke with me for being willing to lend their voices to it.

That’s a great piece of advice that transcends health care reporting: If you are new to reporting on a particular subject, reach out to journalists whose work you admire and pick their brains. 

DG: That checking in I described was Meg’s suggestion — make sure you keep checking in with sources over time, go over things with them before publication, which I would do in any event. That was her recommendation and I found it very helpful.

What is next for you both in terms of this work?

DG: We’re continuing to follow up on things that we have identified and looking at what changes in the wake of it, both at a hospital level and a regulatory level. Sometimes, you drop a big story and there’s some impact right away, but as soon as it is out of the public eye, it is easier for people to go about their business as usual. One of the goals that I have is to keep writing about this, to resurface some of the same themes that we’ve been writing about to make sure it doesn’t fade from public view.  

NB: We know there are investigations from regulators still going on, spurred by our stories. We have yet to hear what has happened with those investigations. We’re still hearing from more people, so I’m pulling thread.

What advice do you have for reporters who want to dig into this topic?

NB: North Tampa Behavioral stood out if you looked at the hospitals that had the most deficiencies in the state. Simple queries like that, at the state or federal level, could point out where your troubled hospitals might be. 

DG: To that I would add, as you keep pulling thread, do course checks. Make sure you are talking to as many people with different perspectives as possible: people who are patients, people who are current and former employees, people who work in the system, people who regulate it. Be listening for different points of view and some dissonance as well. I find myself in a much better position when I get toward the end of a reporting process and I get the response from a company or an executive, but I’ve been checking along the way and have already heard the arguments and had the opportunity to vet their credibility.