Hooked on treatment: Marylanders pay clinic millions, but diagnoses questionable

Marylanders pay millions of dollars to a nonprofit behavioral clinic in Baltimore to help addicts who might not have the underlying psychiatric illnesses it diagnosed, critics say

November 07, 2010|By Scott Calvert, The Baltimore Sun

Kevin Brown knew he was hooked on crack cocaine. That was obvious each time he set off on another smoking binge. But Brown says he never imagined that he also suffered from a mental illness until he walked into Baltimore Behavioral Health Inc.

A day or so after he went to the private, nonprofit Southwest Baltimore clinic in 2007 hoping to kick his drug habit, a psychiatrist diagnosed him with major depression. Soon, he was living in one of BBH's houses, taking antidepressants and spending hours each day in group therapy, half of it focused on mental illness. The treatment lasted months and cost taxpayers thousands of dollars.

But Brown, 46, doubted that he had a psychiatric illness or needed medication. And for good reason, says Amy Jackson, a University of Maryland mental health social worker who counseled him over a recent six-month stretch after he'd relapsed: He never was clinically depressed.

"Once he was no longer using the substance, he was no longer showing signs of the depression," Jackson said. In other words, he suffers from a chemical addiction, and when that is under control, his mind is not burdened by mental illness.

Brown, an addict diagnosed with a psychiatric illness that some outside health providers do not think he has, illustrates a recurring theme at BBH.

Addicts who step into BBH from the city's drug-racked streets are three times more likely to be deemed mentally ill than are addicts treated at other centers across Maryland, state records show.

And BBH has long funneled patients into the costliest outpatient treatment programs available to poor Marylanders — programs they would not qualify for without a diagnosis that they have a psychiatric illness. In some years, state data show, the West Pratt Street center has swallowed up 85 percent of the  taxpayer funds spent on intensive outpatient mental health care across Maryland.

From modest beginnings in 1997, Baltimore Behavioral Health grew by last year into a $17 million-per-year operation, with more than 250 staff members tending hundreds of patients a day, making it one of the region's largest providers of drug treatment. It has diagnosed and treated thousands of the city's most broken and desperate, offering many a bed in its network of area rental homes, then busing them daily to the center for state-funded treatment.

But former patients and employees, as well as outside doctors, say BBH has been diagnosing mental illness — and collecting public money to treat it — in some patients whose main affliction is drug addiction.

BBH is an outpatient mental health clinic that specializes in treating co-occurring drug abuse and psychiatric illness. It mostly bills Maryland's public mental health system, principally Medicaid. And in order to bill that system, a patient's main affliction must be psychiatric rather than drug addiction.

In May, Chief Executive William "Kris" Hathaway said BBH is committed to providing quality care to its patients by blending kindness and clinical rigor to address their physical and mental needs.

"We work very hard to fulfill our mission," he said. "A significant portion of our patients are a very difficult and underserved segment of our society, though we do not wish to foster that image because everyone is equally deserving of respect and compassionate care regardless of their circumstances."

A Baltimore Sun investigation that included dozens of interviews with former patients, psychiatrists and other health professionals, analysis of tax and court records, and a review of state data, found:

•About 90 percent of drug-using patients at Baltimore Behavioral Health, many of them walk-ins, have been deemed to suffer from mental illness, according to the most recent seven years of state health department data. The average is 31 percent for all drug treatment providers in Maryland.

•BBH's frequent and extended use of intensive treatment, coupled with its practice of giving patients multiple chances to get clean, has fueled a boom in billings to the taxpayer-funded state system. Its claims rose from $5.5 million six years ago to more than $17 million in fiscal 2009 before dipping in the last fiscal year.

•BBH has a reputation on city streets, in jails and at area treatment providers for admitting addicts who say they feel depressed, triggering a psychiatric diagnosis that leads to more expensive treatment, according to more than a half-dozen former patients. Two prior patients told The Sun they were advised by BBH staff on what to say at intake — a practice that BBH says would be grounds for firing.

•State data show that by 2004, BBH stood out from other providers for its use of high-cost treatments. Yet state officials in charge of the public mental health system say they noticed this only in 2007. Even then, they did not take steps until fall 2009 to address BBH billings.

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