Up to 45% of mental health inpatients have experienced sexual violence, with one hospital saying its rate of patient sexual assault was within the “industry norm.”

Sexual assault in the inpatient psychiatric setting is a significant problem with serious, lasting consequences, according to research published in the journal General Hospital Psychiatry. The data indicates that between 5% to 45% of mental health inpatients experience sexual violence during an admission.[1] There are increasing reports of unprotected patients being assaulted in behavioral and psychiatric hospitals. Indeed, the study states that “Incidents of sexual assault and engagement or facilitation of engagement of sexual activity with an incapacitated person on inpatient psychiatric units can result in both criminal and civil court involvement.” However, the increasing reports of children being subjected to sexual abuse in privately owned and state-run psychiatric residential centers show a nation where children are put at serious risk, with poor government oversight and protections.

Researchers believe the prevalence of sexual assault in the inpatient psychiatric system is underreported. The study largely relates to the sexual abuse between patients. However, it says earlier evidence indicated that 36% of the programs surveyed reported patient allegations of sexual abuse by a staff member from 1985 to 1991. In England, data recently released following freedom of information requests to the National Health Services revealed nearly 2,500 alleged incidents of sexual violence and misconduct by staff on patients in mental health facilities between 2017 and 2022.[2]

Another recent study published in BMC Psychology studied incidents of “healers that hurt,” in several countries, including the Americas, which determined, “The raping of patients by healthcare providers within healthcare settings calls for urgent and extensive measures.”[3]

A U.S. sexual assault attorney reports that a watchdog group had filed 6,000 complaints about potential negligence and sexual and physical assaults on patients in psychiatric facilities in one year alone. Underreporting, lack of data, and inadequate legal enforcement have all contributed to the conditions that allow sexual assault in psychiatric facilities to persist, the attorney reports. As further explained, “the staff member may use their position of authority to intimidate the patient into abusive conduct or situations.” While in patient-to-patient cases, the abuse can occur due to inadequate supervision.[4]

However, progress has been made. In 2022, a California appeals court affirmed a trial jury’s decision that a psychiatric hospital can be held responsible for sexual abuse committed by an employed caregiver should their actions be enabled by the facility’s “reckless neglect.” This is related to the psychiatric hospital, Aurora Vista del Mar, owned by Signature Healthcare Services, which employed a behavioral health caregiver who sexually abused two patients.[5] In 2019, the psychiatric facility was ordered to pay $13.4 million in civil and punitive damages to the victims.[6]

A federal judge recently denied the North Carolina Department of Health and Human Services’ (DHHS) request to dismiss a lawsuit filed by four foster children accusing it of improperly confining children with disabilities in psychiatric residential treatment facilities, where they allegedly faced abuse, including sexual and physical abuse, and faced “mental health deterioration and cocktails of strong psychotropic medications.”[7]

In October 2020, CCHR documented 32 cases of patient sexual abuse committed between 2004 and February 2020 in behavioral hospitals owned by for-profit behavioral hospital provider Universal Health Services (UHS). These included several convictions of staff responsible.[8] 

One of the most disturbing examples was the now-closed Rock River Academy & Residential Center in Illinois where adolescent girls with emotional problems were incarcerated. Reported in 2015, the Rockford Police Department had fielded more than 700 reports during a four-year period concerning victimization of girls, including “rape, aggravated battery and sodomy at the Rock River Academy.” One girl alleged staff “intentionally administered psychotropic drugs which they used to keep her in a semi-conscious state so that she could be more easily manipulated and sexually abused.”[9]

In 2017, UHS’ Timberlawn psychiatric hospital in Texas closed after a 13-year-old girl was allegedly raped by another patient while under its care. At the time, Timberlawn’s chief executive in a letter to the Dallas Morning News, asserted that “our rate of serious incidents [of sexual abuse] associated with the patient population treated at Timberlawn is within industry norm.”[10]

It’s an “industry norm” that is unacceptable, with little action taken by health and judicial authorities to rectify it, as evidenced by the continuing incidents of reported abuse.

• In March 2024, Fox 13 in Salt Lake City exposed how UHS’s Benchmark Behavioral Health in Woods Cross, Utah, had more child assault cases than any other similar facility in Utah, with at least 61 reports of assault and 36 reports of sex assault since 2019.[11]

• UHS’s Pavilion Behavioral Health System in Illinois was sued over a minor patient allegedly assaulted by another minor in 2020. In 2024, an unprecedented verdict awarded $60 million in compensatory damages and $475 million in punitive damages.[12]

• An 11-year-old girl was admitted to UHS’s Brynn Marr psychiatric hospital in North Carolina after being disturbed by the suicide of a close relative in the summer of 2021. On the day before she was released, she alleged she was sexually assaulted by an older patient. Reports of sexual assault at Brynn Marr are not rare. Local police records showed that Jacksonville police had received 117 calls with reports of sexual assault or rape at the hospital over the last three and a half years.[13] The facility came under months of state and federal scrutiny, jeopardizing its federal insurance reimbursement. Federal regulators threatened to terminate Medicare funding. In March 2023, the Centers for Medicare & Medicaid Services (CMS) removed Brynn Marr’s immediate jeopardy status. However, the hospital remained in noncompliance with every one of the main categories of the Medicare Conditions of Participation for hospitals. These are minimum health and safety standards that hospitals must meet to receive funding from Medicare and to maintain their hospital’s accreditation with the Joint Commission, the nation’s largest hospital accreditation organization.[14]

• The Laurel Oaks Behavioral Center in Dothan, Alabama, owned by UHS, faced a lawsuit over an 8-year-old resident being allegedly sexually assaulted by another resident who had also physically assaulted the victim the day before. It took employees of the facility more than 12 hours to notify the boys’ parents of the assault.[15]

• In October 2022, families said their children were sexually abused at UHS’s North Star Behavioral Health which operates two campuses in Anchorage, and a third in nearby Palmer, Alaska. Federal inspectors found assaults, escapes, and improper use of locked seclusion at the hospital.[16]

• A 17-year-old girl was admitted to the Psychiatric Institute of Washington, a subsidiary of UHS, in 2023.[17] While there, 44-year-old Jerry Mack, allegedly told the girl to follow him to the laundry room, a restricted area, where he sexually assaulted her. Mack was subsequently arrested and charged with First-Degree Sexual Abuse of a Patient. The hospital “suspended” him pending the police investigation.[18]

Reporter Julia Lurie’s award-deserving story about UHS for Mother Jones in October 2023 reported, “In recent years, the company has been the subject of several high-profile lawsuits and investigations, including a blistering BuzzFeed News series in 2016 and a Department of Justice probe that resulted in $122 million in settlements in 2020.” Further, “UHS facilities admitted patients who didn’t need to be there to begin with, failed to provide adequate treatment and staffing, billed insurance for unnecessary services over excessive lengths of time, and improperly used physical and chemical restraints and isolation.”

Lurie continued, “Politicians on both sides of the aisle have decried the company, and Sens. Patty Murray (D-Wash.) and Ron Wyden (D-Ore.) launched an ongoing probe into UHS and other operators of residential facilities for kids in July 2022. Despite all this scrutiny, a large, highly profitable, and easily exploitable group of UHS patients has been overlooked: foster children. A yearlong Mother Jones investigation shows that thousands of foster kids have been admitted in recent years to UHS’s psychiatric facilities, where they typically stay for weeks or months, sometimes leaving far worse off than when they arrived.” The 38 states that provided data to Mother Jones sent foster children to UHS facilities more than 36,000 times between 2017 and 2022. Meanwhile, the 31 states that responded to Lurie’s Medicaid query spent more than $600 million on the treatment of foster children at UHS facilities over the same period.[19]

That puts this vulnerable group of children at risk of the “industry norm” rate of sexual assault.

The abuses are not limited to facilities owned by UHS.

• On April 7, 2024, Fox 13 News in Utah reported that Highland Ridge Hospital, a for-profit psychiatric owned by Acadia Healthcare is set to close on May 7, following a FOX 13 News investigation revealing repeated sexual assaults within the institution, which has earned it the moniker “The Rape Hospital.”[20] Officers had responded to over 100 cases at the facility since 2019.[21]

• In 2019, Chicago Lakeshore, owned by Signature Healthcare Services, was called a “hospital of horrors.” The Cook County public guardian alleged children as young as 7 were sexually abused and others were injected with sedatives and physically attacked — all while officials covered it up. Child welfare officials, meanwhile, allegedly worked with the hospital to cover up the abuse. One 14-year-old girl, according to a lawsuit, was allegedly sexually assaulted multiple times by a nurse who showed her pornographic videos as well as she and others were allowed to fill out their own medical paperwork and to use the nurse’s vaping device. The lawsuit also claims a male hospital employee entered the room of a 12-year-old girl and forced her hand on his genitals and grabbed her breasts.[22]

• In July 2019, Red Rock Canyon School, a behavioral facility in St. George, Utah owned by Sequel Youth & Family Services, closed after the state threatened to revoke its license following a riot and revelations about staff abuse and assault. A June 2019 report found that police had been called to the school 72 times since 2017. During the same period, 23 staff members were investigated for child abuse, nine were charged, and four more were referred for charges.[23]

• In April 2023, a nurse was accused of sexually assaulting a 13-year-old at Green Bay mental health clinic in Wisconsin and faces six charges, including three of second-degree sexual assault of a child under age 16. A 16-year-old girl also told police the nurse would only give her medication if she exposed herself to him.[24] (The nurse denied the allegations and has pleaded not guilty.[25])

• In 2023, the Nevada Department of Health and Human Services revoked the license of a youth psychiatric facility, Never Give Up Youth Healing Center, in Nye County that has been plagued with allegations of child abuse and sexual assault. Four adults associated with Never Give Up are facing criminal charges in separate cases ranging from allegations of child abuse to sexual assault of a minor, the Sheriff’s Office has said. The facility is facing more than $350,000 in fines from the state health department over allegations that staff unnecessarily, and sometimes violently, restrained children and failed to address other ongoing problems, the Review-Journal reported. Multiple lawsuits against the facility are also active in Nye County, alleging that patients were sexually assaulted by staff and other patients.[26]

• In February 2024, the advocacy group Disability Rights New Jersey filed a lawsuit against state officials alleging harrowing conditions and systematic violations of patient rights in four state-run psychiatric hospitals. It is alleged that the “reality on the ground” at Ancora Psychiatric Hospital, Greystone Park Psychiatric Hospital, Trenton Psychiatric Hospital and Ann Klein Forensic Center is “more akin to psychiatric incarceration” than to a setting where patients can get proper care. “Individuals have been sexually, physically, and emotionally assaulted, sometimes resulting in permanent injuries or death,” Disability Rights New Jersey said. The suit says seven “unexpected deaths” occurred in the hospitals between March 2019 and June 2022, ascribing them to inadequate supervision, delayed medical responses and failures to follow safety procedures.[27]

• In April 2024, Maya Hayes, 46, an associate psychologist at Brookwood Secure Center for Youth in Claverack, New York, was arrested and charged with 65 counts of criminal sexual acts, including three counts of rape, involving eight victims aged between 16 and 18 between 2020 and 2022. Brookwood is one of three secure juvenile detention facilities overseen by the state Office of Children and Family Services, housing male and female offenders who committed certain violent felonies before turning 16 and were convicted and sentenced in adult criminal court or family court under the Raise the Age legislation.[28] As an associate psychologist in New York, she is unlicensed but works under the supervision of a licensed psychologist. “These predatorial crimes serve as an unfortunate reminder that our state’s most vulnerable populations are particularly susceptible to abuse. The people of New York, and especially our youth communities, deserve better,” said New York State Justice Center Executive Director Maria Lisi-Murray. “In creating the Justice Center, New York established the strongest protections in the country for individuals with special needs, including those receiving services at youth detention centers. We must ensure justice is served for these young victims, and we will use every method within our power to hold Ms. Hayes accountable for her actions.”[29]

• In March 2021, an earlier lawsuit was expanded that alleged sexual and physical abuse of more than 30 children at a New Hampshire state-run youth detention center, formerly known as the Youth Development Center in Manchester, now called the John H. Sununu Youth Services Center. The case expanded to more than 230 children spanning six decades. Eleven former state workers face criminal charges, and dozens more are accused in the nearly 1,200 lawsuits former residents have filed against the state alleging abuse spanning six decades. Attorney Rus Rilee of Bedford filed the lawsuit in Merrimack County Superior Court in January 2020 on behalf of 32 people. Since then, another 200 people have come forward alleging they were abused at the facility which housed about 100 – 110 youth, ages 11 to 17 who were sent there through judicial proceedings for offenses as minor as repeatedly running away from home to the most serious including homicide. Perpetrators include 150 staff with more than half of them accused of sexual abuse. Children were allegedly gang raped by counselors, beaten while being raped and forced to sexually abuse each other. Amanda Grady Sexton, director of public affairs for the New Hampshire Coalition Against Domestic and Sexual Violence, said, “It’s unconscionable to think that dozens of boys and girls experienced horrific sexual, physical, and emotional abuse at the hands of those whose sole duty was to protect and care for them.”[30]  

Investing in Psychiatric Child Abuse

All of these abuses occur while the facilities are reimbursed by Medicaid, Medicare and private insurers, while the for-profit psychiatric facilities also reap investor dollars that are swayed by reported profits. Private psychiatric hospitals are the second largest group of providers of inpatient care.[31] In 2015, nearly 40% of the $8 billion in all revenue (acute care and behavioral) that UHS generated annually came from Medicare and Medicaid reimbursements.[32]

For Acadia Healthcare, according to a report filed with the Securities and Exchange Commission in 2023, 54% of its revenue was from Medicaid, 28% from commercial payors; 15% from Medicare and 3% from other payors.[33] In 2015, Acadia described the investment environment for behavioral facilities in the U.S. as a “large market with attractive trends.” [34]

Violation Tracker, a database on corporate misconduct, lists 11 fraud cases against Acadia between 2000 and 2019 resulting in $26,521,878 in fines and settlements. Of this, $26.4 million was government-contracting-related offenses, including False Claims Act actions; $110,878 was employment-related and $11,000 was safety-related issues.[35] Add to that $325 million for a civil lawsuit in 2023 and in 2022, Acadia DBA Roanoke Comprehensive Treatment Center (RCTC) paid $348,934 to settle False Claims Allegations.[36] A total of $351,870,812.

Yet, investors still see the behavioral market as lucrative, which for-profits can take advantage of.  

The Private Equity Stakeholder (PES) Project report, “The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth,” released on 17 February 2022, concluded: “Private equity’s track record for investing in youth behavioral services is troubling. A pattern of harmful conditions, often related to insufficient staffing and other cuts to expenses, suggests that private equity firms’ focus on maximizing profit over short periods of time may come at the cost of children’s and teens’ safety and well-being. Despite horrific conditions at some youth behavioral health companies, their private equity owners have in some cases reaped massive profits.” Firms often aim to double or triple their investment over 4-7 years.[37]

The for-profit Sequel Youth and Family Services, now known as Vivant, once boasted revenue of more than $200 million and that the profits were between $30 to $32 million. Jay Ripley, the co-founder of Sequel, said, “You can make money in this business if you control staffing.[38] Sequel was owned by different private equity firms for at least 13 years. One, Alaris Royalty, reported generating a $71 million profit, or 23% annual return, on its investment in the company, according to the PES Project report.[39]

In December 2019, the national firm Bass Berry & Sims issued a report, “Pros & Cons of the Behavioral Health Sector Investing,” which stated: “One benefit to investors are the statutory and regulatory changes over the last 10 years — including The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Affordable Care Act — that increased the number of beneficiaries enrolled in health plans that provide mental health and substance use disorder (MH [mental health] & SUD [Substance Abuse Disorders]) benefits, thereby creating the potential for higher reimbursement rates.”[40] 

In response to the pervasive sexual abuse and assault within psychiatric facilities, CCHR condemns the mental health industry for endangering children and profiting from it. CCHR demands comprehensive oversight, stringent protections, and swift consequences for facilities found negligent. Legislative and regulatory reforms are needed to address systemic failures, hold facilities accountable, and prioritize patient safety over profit. Collaboration among policymakers, healthcare professionals, advocacy groups, and the public is essential to enact meaningful change and ensure that no child or patient suffers such horrors in psychiatric facilities.

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[1] Holly Betterly, et al., “Sexual assault in the inpatient psychiatric setting,” General Hospital Psychiatry, 13 June 2023, https://www.sciencedirect.com/science/article/abs/pii/S0163834323000270

[2] “NHS England mental health trusts record 26,000 sexual abuse incidents,” The Guardian, 23 May 2023, https://www.theguardian.com/society/2023/may/23/nhs-england-mental-health-trusts-record-26000-sexual-abuse-incidents

[3] “Healers that hurt: a scoping review of media reports of cases of rape in healthcare settings,” BMC Psychology, 16 Apr. 2024, https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-024-01721-w

[4] Jessica Pride, Attorney, “Sexual Assault in Psychiatric Facilities: Why Is It So Common?” 18 Aug. 2022, https://www.survivorlawyer.com/blog/sexual-abuse-psychiatric-facilities

[5] Dave Muoio, “Psychiatric hospitals can be held responsible for employees’ sexual abuse of patients, court rules,” Fierce Healthcare, 2 Apr. 2022, https://www.fiercehealthcare.com/providers/psychiatric-hospitals-can-be-held-responsible-employees-sexual-abuse-patients-appeals

[6] https://www.cchrint.org/2020/01/13/for-profit-psychiatric-hospitals-a-year-of-police-raids-staff-arrests/; “Psych hospital owner testifies in Vista del Mar trial over ex-worker’s sexual misconduct,” VC Star, 16 Jul. 2019, https://www.vcstar.com/story/news/local/2019/07/16/aurora-vista-del-mar-trial/1720652001/

[7]“ Federal judge won’t stop lawsuit against NC over kids confined in psychiatric residential treatment facilities,” Carolina Public Press, 12 Apr. 2024,  https://carolinapublicpress.org/63716/prtfs-confine-children-nc-federal-lawsuit-judge-allows/

[8] Child Abuse Allegations in the Behavioral-Psychiatric Industry: Universal Health Services (UHS) https://www.cchrint.org/2020/10/30/child-abuse-allegations-in-the-behavioral-psychiatric-industry-universal-health-services-uhs/

[9] https://www.cchrint.org/2020/10/30/child-abuse-allegations-in-the-behavioral-psychiatric-industry-universal-health-services-uhs/; Lorraine Bailey,” Severe Abuse Alleged at Illinois Home for Girls,” Courthouse News.com, 10 Sept. 2015, https://www.courthousenews.com/severe-abuse-alleged-at-illinois-home-for-girls/

[10] https://www.cchrint.org/2017/12/12/psych-hospital-chain-uhs-facing-more-allegations/; Sarah Mervosh, Sue Ambrose, “‘Immediate jeopardy’: How safe are kids at state-monitored Timberlawn psych hospital?” The Dallas Morning News, 10 Dec. 2017, https://www.dallasnews.com/news/investigations/2017/10/26/timberlawn-history-sexual-assault-reports-13-year-olds-case-surfaced

[11] Adam Herbets, “This psychiatric hospital has more child assault cases than any other in Utah,” Fox 13 News, 18 Mar. 2024, https://www.fox13now.com/news/fox-13-investigates/this-psychiatric-hospital-has-more-child-assault-cases-than-any-other-in-state-of-utah

[12] Morgan Gonzales, “UHS To Pay $535M In Sexual Assault Suit,” Behavioral Health Business, 1 Apr. 2024, https://bhbusiness.com/2024/04/01/uhs-to-pay-535m-in-sexual-assault-suit/

[13] Taylor Knopf, “Durham 11-year-old was sexually assaulted in NC psychiatric hospital, parents allege,”  NC Health News, 30 Nov. 2022, https://www.northcarolinahealthnews.org/2022/11/30/parents-allege-11-year-old-sexually-assaulted-in-nc-psychiatric-hospital/

[14] Taylor Knopf, “NC psych hospital failed to provide ‘safe and therapeutic’ environment, feds say,” NC Health News, 10 May 2023, https://www.northcarolinahealthnews.org/2023/05/10/nc-psych-hospital-failed-to-provide-safe-and-therapeutic-environment-feds-say/

[15] “Alabama Youth Facility Sued Over Another Child Sexual Assault Incident,” LR News, 4 Feb. 2024, https://levin-papantonio-rafferty.prowly.com/290507-alabama-youth-facility-sued-over-another-child-sexual-assault-incident

[16] Michelle Theriault Boots, “Alaska families say their children were sexually abused at North Star psychiatric hospital,” Anchorage Daily News, 11 Oct. 2022, https://www.adn.com/alaska-news/anchorage/2022/10/11/two-alaska-families-say-the-children-they-sent-to-north-star-were-sexually-abused-at-the-psychiatric-hospital/; Michelle Theriault Boots, “Federal inspectors fault assaults, escapes, improper use of locked seclusion at North Star youth psychiatric hospital,” Anchorage Daily News, 30 Sept. 2022, https://www.adn.com/alaska-news/2022/09/28/federal-inspectors-fault-assaults-escapes-improper-use-of-locked-seclusion-at-north-star-youth-psychiatric-hospital/

[17] https://www.practicematch.com/employer/psychiatric-institute-of-washington-piw-/635452/

[18] Amber Anderson, “Teen patient sexually abused by hospital employee, police say,” WUSA9 News, 21 Dec. 2023, https://www.wusa9.com/article/news/local/dc/teen-sexual-abuse-psychiatric-institute-washington-man-arrested/65-e6ab89e6-cc9b-4aaa-8725-4803a15f9e24

[19] Julia Lurie, “Inside the Psychiatric Hospitals Where Foster Kids Are a “Gold Mine: How a scandal-plagued health care giant profits off a failing child welfare system,” Mother Jones, Sept.-Oct. 2023,  https://www.motherjones.com/criminal-justice/2023/10/foster-kids-psychiatric-hospitals-universal-health-services-uhs-alaska-cps/

[20] “Utah psychiatric hospital to shut down after years of safety concerns exposed by FOX 13 Investigates,” Fox 13 News, 4 Apr. 2024, https://www.fox13now.com/news/fox-13-investigates/watch-the-fox-13-investigations-leading-up-to-shutdown-of-highland-ridge-hospital

[22] Daub Eldeib, “A Chicago Psychiatric Hospital Is Under Fire After Child Abuse Allegations. Again,” ProPublica, 18 Dec. 2019, https://www.propublica.org/article/chicago-lakeshore-hospital-child-abuse-allegations-federal-lawsuit

[23] https://www.cchrint.org/2022/02/21/the-kids-are-not-alright-report-confirms-profit-is-put-before-troubled-teens-mental-health-safety/; The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth,” Private Equity Stakeholder Project, 17 Feb. 2022, p. 15, https://pestakeholder.org/wp-content/uploads/2022/02/PESP_Youth_BH_Report_2022.pdf

[24] “Ysurf Shariff is also accused of telling a 16-year-old to expose herself to get her medication,” WBAY, 26 Apr. 2023, https://www.wbay.com/2023/04/26/nurse-accused-sexually-assaulting-13-year-old-green-bay-mental-health-clinic/

[25] Brian Kerhin, “Green Bay hospital nurse pleads not guilty to sexual misconduct charges,” FOX 11 News, 28 Sept. 2023, https://fox11online.com/news/local/green-bay-hospital-nurse-pleads-not-guilty-to-sexual-misconduct-charges-ysurf-shariff-underage-patients-mental-health

[26] “State closes youth psychiatric facility at center of RJ investigation,” Pahrump Valley Times, 2 May 2024, https://pvtimes.com/uncategorized/state-closes-youth-psychiatric-facility-at-center-of-rj-investigation-121161/

[27] Gene Myers, “Lawsuit alleges harrowing conditions, abuse in New Jersey psychiatric hospitals,” AOL.com, 21 Feb. 2024, https://www.aol.com/lawsuit-alleges-harrowing-conditions-abuse-225458526.html

[28] Phillip Pantuso, “Psychologist arrested for sex crimes at youth detention facility,” Times Union, 15 Apr. 2024, https://www.timesunion.com/hudsonvalley/news/article/brookwood-secure-center-psychologist-arrested-rape-19403664.php; https://troopers.ny.gov/news/state-psychologist-arrested-sexual-assault

[29] Jackson Tollerton, Zion Decoteau, “State psychologist indicted for multiple sexual assaults,” ABC News 10, 16 Apr. 2024, https://www.news10.com/news/crime/state-psychologist-indicted-for-multiple-sexual-assaults/

[30] Pat Crossmith, “More than 200 more join lawsuit alleging abuse as children while living in state-run detention center,” Ink Link, 3 Mar. 2021, https://manchesterinklink.com/more-than-200-more-join-lawsuit-alleging-abused-as-children-while-living-in-state-run-detention-center/; “A lawsuit alleging abuse at a NH youth center is going to trial. There are 1,000 more to come,” WBUR, AP, 9 Apr. 2024, https://www.wbur.org/news/2024/04/09/sununu-youth-services-center-abuse-lawsuit-trial

[31] “Trends in Psychiatric Inpatient Capacity United States and Each State, 1970-2018,” National Assoc. of State Mental Health Program Directors Research Institute, Inc. (NASMHPD), Sept. 2022

[32] https://whyy.org/articles/profitable-mental-health-service-provider-under-medicaidmedicare-investigation/

[33] United States Securities and Exchange Commission, Acadia Healthcare Co., Annual Report 2023, https://www.annualreports.com/HostedData/AnnualReports/PDF/NASDAQ_ACHC_2023.pdf

[34] Acadia Healthcare, Investor Presentation, 2015, p. 13

[35] https://violationtracker.goodjobsfirst.org/parent/acadia-healthcare

[36] “Roanoke-based opioid treatment center to pay $348K in ‘improper billing’ case,” ABC News, 19 July 2022, https://wset.com/news/local/roanoke-comprehensive-treatment-center-virginia-opioids-to-pay-348k-improper-billing-case-civil-case-settled

[37] https://www.cchrint.org/2022/02/21/the-kids-are-not-alright-report-confirms-profit-is-put-before-troubled-teens-mental-health-safety/; “The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth,” Private Equity Stakeholder Project, 17 Feb. 2022, pp. 3 and 21, https://pestakeholder.org/wp-content/uploads/2022/02/PESP_Youth_BH_Report_2022.pdf

[38] https://www.cchrint.org/2022/02/21/the-kids-are-not-alright-report-confirms-profit-is-put-before-troubled-teens-mental-health-safety/#_edn23; Bennett Haeberle, “More states sever ties with for-profit Sequel Youth and Family Services after reports of abuse,” 10 WBNS News, 17 Dec. 2020, https://www.10tv.com/article/news/investigations/10-investigates/more-states-sever-ties-with-sequel-youth-and-family-services-after-reports-of-abuse/530-b6f995b7-13c3-40a5-8893-5326af948a19

[39] Michelle Conlin, Reuters, “Private equity’s latest play: the troubled kids industry,” 17 Feb 2022,  https://www.reuters.com/business/private-equitys-latest-play-troubled-kids-industry-2022-02-17/ citing, “The Kids Are Not Alright: How Private Equity Profits Off of Behavioral Health Services for Vulnerable and At-Risk Youth,” Private Equity Stakeholder Project, 17 Feb. 2022, p. 4, https://pestakeholder.org/wp-content/uploads/2022/02/PESP_Youth_BH_Report_2022.pdf

[40] Bass Berry & Sims, “Pros & Cons of Behavior Sector Investing,” 11 Dec. 2019, https://www.bassberry.com/wp-content/uploads/behavioral-health-private-equity.pdf