The Costs of Burdening People with Medical Bills for Involuntary Psychiatric Hospitalization

Years ago, when I was a third-year law student just a few credits away from graduating, I experienced a serious mental health crisis. My psychiatrist at the time involuntarily committed me to a private psychiatric facility in Oakland, California.

Because I was enrolled in law school, I had private health insurance. This meant I was insured during the initial stay at the facility. Yet, because I could not re-enroll in school for the following semester, I lost my insurance while hospitalized. As a result, the facility discharged me to a friend’s house, even though I was far from being psychiatrically stable.

The subsequent year was one full of instability and trying to recover. I nevertheless managed to complete my remaining credits and thus graduate from law school. I could only do this because people in my life financially supported me through my struggles. I embarked on a path of recovery that eventually led me to becoming an attorney with Disability Rights Washington.

Recovering from an involuntary psychiatric hospitalization can be an extremely arduous journey. The trauma of having a serious mental health crisis compounded with the trauma of psychiatric hospitalization can make re-piecing one’s life together challenging, to say the least. That hardship is exacerbated when faced with hospital bills. NPR recently published a story about how the cost of psychiatric care—including involuntary care or care that one may not have had the capacity to consent to at the time of treatment—can be ruinous for many.

To my dismay, more than six years after my hospitalization, I saw on my credit report that a medical bill from my hospitalization in Oakland had been sent to collections. I had never seen the bill before and certainly had no idea that anyone was pursuing the debt.  Seeing the bill for the first time on my credit report was very stressful and overwhelming. It felt like such an injustice that I would now have to fight a bill for treatment that I did not choose or have the capacity to consent to at the time.

The stain on my credit report was just another reminder of what I had gone through and the many kinds of difficulties a person faces when trying to move on and recover from such a traumatic experience. Even years after the fact and with my own legal expertise, it was still difficult for me to summon the energy to fight unfair billing practices. I was in a relatively privileged position—I am an attorney and have the ability to research and assert my rights—but how many others have had to experience such billing practices when they are trying to recover from a serious mental health crisis and have very few resources to defend their rights?

While there are laws protecting those who experience involuntary psychiatric hospitalization, including around billing, many who go into psychiatric care do not have the emotional and psychological wherewithal to enforce their rights once they are released from treatment. As such, people who have been involuntarily hospitalized rarely seek a lawyer to fight medical debts incurred. If they did, facilities would be strongly incentivized to drop the bills when faced with the prospect of costly legal battles or losses.

Fair billing laws like California’s Hospital Fair Pricing Act of 2006 (and the more recent Health Care Debt and Fair Billing law) place obligations on hospitals and treatment facilities to provide patients with notice of the availability of charity care and/or financial assistance before reporting any debt to collections. These laws can also set limits on how much hospitals can charge patients whose incomes are below a certain threshold.

As a lawyer, the first thing I did was to research the statute of limitations on medical debt in California, which is four years. This meant that my alleged debt was no longer legally enforceable. Medical bills nevertheless remain on credit reports for a total of seven years. My choice then was between potentially spending a lot of time fighting the bill or simply waiting some months for the bill to disappear from my credit report. Since I was already spending most of my mental energy working as a disability rights attorney focusing on other issues, I chose the latter and the bill eventually disappeared from my credit report. Others may not be so fortunate and could even face debt-related lawsuits while still recovering from serious mental health crises.

While those who have been involuntarily hospitalized have rights regarding billing practices, it is exceedingly unfair to expect them to seek out legal help to enforce their rights. People who are discharged from treatment facilities are often in pure survival mode. Their immediate needs may include navigating where they are going to stay, how they will feed themselves, and how to access treatment options outside of hospitalization. The last thing they need is to deal with medical bills in collections, or, even worse, lawsuits related to medical bills. And making things more difficult is that available legal assistance is often limited to legal aid organizations that are generally under-resourced and stretched thin.

I’ve had the privilege of experiencing access to universal healthcare, having lived in Denmark as a teenager, and as such, I strongly believe that all medical care should be free and accessible to all people. I believe this is especially true for psychiatric care. It feels particularly unethical to hold people financially responsible for care they are forced into against their will or do not otherwise have the capacity to consent to. Instead of putting the onus on individuals to enforce their rights when they are trying to recover from mental health crises and the accompanying hospitalizations, we as a society must ensure that psychiatric care is never billed to the individual.

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