mental hell

How the American health-care system killed a 13-year-old girl.

Published October 3, 1997 11:03AM (EDT)

In Nov. 1991, Merry Scheck admitted her 13-year-old daughter Christy to a psychiatric hospital near their San Diego Home. Once an honor student and gifted athlete, Christy had become suicidal, hiding razor blades and aspirin bottles in her room and telling her friends that life at home was unbearable. The Schecks were a close, religious family. Christy had always maintained healthy relationships with her parents, especially her father, Bob, who coached her sports teams and practiced pitching, throwing and hitting with his daughter every chance he could. But when Christy approached adolescence and her father decided she should no longer play in boys leagues, she was furious, and her behavior became irrational and self-destructive. On the advice of a family therapist, the Schecks checked their daughter into Southwood Psychiatric Hospital. Five months later, she hung herself while on suicide watch.

What the Schecks didn't know when they admitted Christy to Southwood was that it was one of 70 psychiatric hospitals affiliated with National Medical Enterprises, a $4 billion player in the mental health business. In her new book, "A Wrongful Death: One Child's Fatal Encounter with Public Health and Private Greed," reporter León Bing interweaves the Scheck's haunting personal story with a tale of corporate health care gone horribly awry. Chapter by chapter, the Scheck story unfolds, revealing a picture of a mental health system largely devoid of compassion and competence -- and an institutional structure based primarily on profit, where patients with generous insurance policies receive expensive and lengthy hospital stays that often do more harm than good.

Salon recently spoke to Bing about trendy psychological theories, her own experience working at a psychiatric hospital and why, when it comes to health care, insurance is everything.

You worked as a "tech," someone who ushers kids to and from therapy and chaperones at meals and activities, at a private psychiatric facility in Southern California similar to the one that Christy Scheck was in. Techs have the most contact with kids, but you write that in order to get hired you were interviewed briefly, given a cursory medical exam and two days later you were hired.

Yes, I worked for a facility that is no longer in operation, during the summer of 1985, but I only lasted for three months. I asked too many questions. At the time I was hired, I thought, this is easy enough, this is pretty fast. Techs were part-time, on-call workers, with no benefits, who could be paid almost a minimum wage. So, if you were able to understand directions, and provide answers that showed that you comprehended them, it seemed pretty clear that you'd get hired.

After I left the facility, I wrote a cover story about it for the L.A. Weekly that nearly broke their record for mail received. It seemed that every kid in the L.A. area who had been put in one of those places wrote in. So I kept that in the back of my mind and knew I wanted to write a book about it. And then as more and more atrocities came to the surface, I realized it was the time.

What atrocities?

There was a case in Texas in which a 14-year-old boy was picked up at his house and taken in handcuffs to a private psychiatric hospital for supposed drug abuse. He was kept for five days without being allowed to see or speak to his family; he tested negative for drugs and wasn't even seen by a psychiatrist until two days after he got there. So a suit was brought against the hospital chain, Psychiatric Institutes of America (PIA), which also ran the hospital that Christy Scheck was placed in.

This book did not start out being about Christy Scheck.

In 1993 I began interviewing kids. One of them, Lynn Duff , was on Barbara Walters a couple of weeks ago talking about how she had been in effect kidnapped by her family and driven to Utah with a hood over her head to a facility there called Rivendell. Her mother put her there because Lynn had told her that she was gay. I interviewed Lynn at great length. She was going to be one of the chapters in the book; I was going to do different chapters on different kids. Then in 1994, I read an article that had to do with a settlement made by National Medical Enterprises (the corporate parent of PIA) to the Scheck family because of the death of their 13-year-old daughter at one of these facilities in a suburb of San Diego.

I called the Scheck's attorney to ask if I could meet with them, and he said he didn't think they wanted to talk to a member of the press -- which I understood, of course, as a parent, if nothing else. But about a week later Merry Scheck called me. And what started out as a chapter on Christy Scheck ultimately overtook the book. I mean, I had talked with some kids who had riveting accounts, but this overshadowed all of them. Those kids were still alive. Christy was dead.

Did the stories that you heard from the kids you interviewed corroborate and round out what you learned from the Schecks?

I had interviewed all of those kids, and I had worked in one of those facilities. You know when something has a ring of truth, and when you have been there to witness it, well, there is not much problem believing it. And I am not a "believing" person by nature.

Were any of the kids you worked with -- or interviewed -- helped by the treatment they received in these hospitals?

If the kid gets lucky, they are helped. No matter what the bylaws of the facility are, if they are hooked up with the right shrink they are going to be helped. Or if the kid was open to being there, they might be helped. But unfortunately many of the kids I worked with were lied to by their parents, by their school counselors or by both. My question at staff meetings was, "How are these kids ever going to trust their parents or any authority figure again?"

How do they navigate the adult/authority world, once they get out?

It depends. Remember, they are being sent back to the exact same environment. Same people, same kind of happenings that put them there in the first place. I sat in on one parent-child meeting and it was amazing. The mother did nothing but shriek at the kid for the hour and justify the fact that she had read the girl's diary and gone through her drawers.

You write about the tactics that these facilities use in order to play on parents' fears. You call it the "what if" approach.

The ad copy for these hospitals will read something like "It could be growing pains, but what if it's not?" or "The moods and the roach you found in the back of the car could just be typical teenage behavior, but what if it's not?"

How can parents make sure they are not getting duped by good PR?

They have to ask questions like, What is the history of the parent company? Are the people at this facility compassionate? Have they sold out to trendy psychological theories? The Schecks clearly tried to make the right choice, and tragically they didn't.

What are some examples of "trendy psychological theories"?

Examples of trendy theories are recovered memory syndrome and the anger reduction stuff, where a kid is held while insults and abuse are hurled at them. Naturally, the kid freaks out, but they are being held down. I once saw this on a PBS show, and my jaw was hanging. One common theory is that if you have an eating disorder, then you must have been sexually abused by your parents. I find all of these really frightening.

While hospitalized, Christy Scheck accused her father of sexual molestation, a charge that you write she fabricated as a way to become closer with the hospital staff.

She wanted to gain the approval of the staff, but she also wanted to one-up her peers. She made up stories about being in a gang, then that she was kidnapped and raped. When those didn't create ripples either, she said she was molested. It was guaranteed to draw a collective gasp.

How did the counselors at the hospital facilitate Christy's charade?

When Ed Dueñez, Christy's high school guidance counselor, went to spend Thanksgiving with her at the facility three weeks after she was there, he realized something was seriously wrong. She was sitting at the table having dinner with three other kids and she began emulating their rap, their whole street attitude. Dueñez approached one of the counselors and said, "When are you going to confront her with her real life?" The counselors said, "We know what we're doing." Which is also what the Schecks got. Obviously they didn't know what they were doing.

In the book, Merry and Bob Scheck admit that to this day, they don't know what Christy's treatment was. Why weren't the Schecks more aggressive? Why didn't they yank her out?

I must defend them here. Merry Scheck was on the phone constantly, she tried every way she could to get a handle on the kid's treatment. She was not concerned with popularity for even an instant. But they had to be careful because the more they tried to get in contact, the more they were kept in the dark. Had there been front line people who were more in touch with the proper treatment, who at least knew what they were doing, who at least didn't suddenly decide to believe everything the kid said in order "to give her her own credibility," then I don't think the Schecks would have been kept so much in the dark.

Still, they knew Christy wasn't making much progress. Why not take her out?

Well, by the time this was starting to happen, their younger daughter had been taken from their home. (The Scheck's other daughter, Molly, was taken away from them after the abuse charge was leveled against Bob Scheck.) Christy would then have been moved into a foster home with God knows what results. I know no one ever expected what happened to happen. They felt that at least their child was safe because she was being watched by professionals. They were not told that she had been put on a suicide watch. All of us, especially parents, can say, "How could they have been so passive?" But the fact is that they were blindfolded and hooded, and put into one of those Skinner boxes, as far as their child's treatment.

Are there any laws that protect a parent's right to know what is going on when they admit their child to a psychiatric hospital?

I wish I knew. That is a lapse in my own investigative journalism.

Christy Scheck had great insurance coverage because her father had been in the military. How long would she have stayed at Southwood if her coverage wasn't so comprehensive?

She would have been out of there quickly because they would have wanted to make room for a big payer. I imagine her treatment would have been a bit different because her parents would not have been able to pay out-of-pocket. In the book there is an example of a Medicare patient, whom I called Amber, who ended up in a coma due to an overdose she suffered when she was moved out of the hospital. They moved her before her insurance was even up, to make room for a high payer.

Christy was placed on high doses of sedatives and psychiatric drugs, much higher than what is normally recommended for adolescents. Is it common practice to drug up the kids?

Apparently, it is pretty prevalent. And the charging, the capricious charges are just staggering. In this instance, Christy's case was not isolated.

In the book you explain a phenomenon called "charting parties."

Patient charts were in fact changed. At Southwood, pizza was brought in and charts were changed to reflect treatment that was probably not given, but was put down on the patients' charts so it would be paid for. One memo was sent out saying, don't say "bright affect," which means good mood, say "manic episode." That is an example of creative charting. When I was working at the psychiatric hospital, there were kids, little kids, who had been there for years and would be there as long as the insurance paid for it. They could be there until they were 18. It wasn't just in California. It was pretty much all over the country.

Insurance companies were completely screwed by these private hospitals. Wasn't there some kind of system of checks and balances?

Only when cases like the one in Texas began to show up, and state senators started forming panels, did this start bubbling up to the surface -- and this wasn't until the very late '80s when hearings began.

What has happened to NME, the corporation the Scheck's brought suit against?

In August, $100 million was paid to settle 700 claims filed by former psychiatric patients at NME hospitals. Most of these patients, at the time of their hospitalizations, were teenagers. Aside from that $100 million, doctors once affiliated with that psychiatric unit agreed to pay an extra $20 million in compensation to their former patients.

As a parent and someone who has done extensive research, what do you think a parent should do before admitting their child to a facility?

A parent must have a split-level view: knowing your child is in crisis, and yet keeping it together in order to thoroughly check out the facility. When a child is at a crisis point, tragically, understandably, most parents will hand over their child to people with at least what looks like some expertise and credentials. It does become a kind of crap shoot, or a slot machine in Vegas. Sometimes you come up with lemons or cherries, or sometimes it is just a blur of light and color, no payoff. At the worst level, it is what happened to Christy Scheck.

By Lori Leibovich

Lori Leibovich is a contributing editor at Salon and the former editor of the Life section.

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