A  not-for-profit clinic in Maryland has been called-out for diagnosing addicts with mental illness when they really didn’t have an underlying mental illness. Once addicts like crack-smoker Kevin Brown (who had been diagnosed with clinical depression and was receiving expensive treatment for both his addiction and mental illness), got off crack, the mental illness went away.

Meanwhile, the clinic, 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,” according to this article in the Baltimore Sun.

In order to bill Medicaid for treatments, providers like BBH must diagnose mental illness–addiction alone won’t qualify for reimbursement. BBH therefore gives mental illness diagnoses to addicts who come to it for treatment at a rate of about 90 percent, versus 31 percent statewide.

I have mixed feelings about this story. On the one hand, it does sound like there might possibly be fraud. On the other, my experience has been that most addicts who do have mental illness are regularly under-diagnosed!

In the world of addiction, there are two main types of mental illness. There are those mental illnesses that precede substance abuse, and in fact, may contribute to it–sometimes those with mental illness abuse alcohol and drugs in order to “medicate” themselves in an effort to find relief from symptoms of mental illness.

There are also mental illnesses that are caused by substance abuse. These may be temporary.

Or, if brain/neurological damage occur, may be long term, or even incurable.

Finally, addicts may actually have both kinds of mental illness.

My clinical experience has led me to believe that many addiction-treatment clinicians are simply not equipped to  diagnose mental illness and whether or not it precipitated or was triggered by, substance abuse.

Psychiatrists at most outpatient addiction treatment clinics are usually there to prescribe, not diagnose. Licensed mental health counselors who like psychologists, have trained in testing and evaluations, are not always on staff because of the expense.  Other clinicians simply don’t have the training to diagnose mental illness, and in fact, that’s not really their job.

In order to “tease” out an accurate diagnosis so treatment can be truly effective, time is needed. Some addiction clinics (not all), people-batch–that is, they overload caseworkers and pressure clinicians to treat as many people as possible in order to up their Medicaid reimbursements. It is an industry that is ripe with opportunities for fraud. And, I am sorry to say, fraud does occur.

However, just because a mental illness rate of addicts at 31 percent is deemed average doesn’t mean it’s accurate. In fact, I believe the rate to be higher.

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    Last reviewed: 8 Nov 2010