If you suffered sexual abuse at a residential treatment facility (RTF), you are not alone. RTFs are intended to support vulnerable young populations suffering from mental health, substance use, and behavioral challenges. Troubled children and youth enter these facilities expecting help and support yet the very people tasked with helping them are sometimes the ones who cause further trauma.
In 2024, the Senate Finance Committee released a scathing report revealing widespread abuse and neglect at many youth RTFs across the country. Based on a two-year investigation into dozens of facilities, including those in Massachusetts, operated by four of the largest behavioral health providers in the country—Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare—the report reveals that RTF providers frequently optimize profit over the wellbeing and safety of children and youth. While this report concerns placements financed by Medicaid and the child welfare system, children whose stays are covered by private and public funds often overlap in the same programs, including in facilities at-issue in this investigation.
A key finding of the investigation is that children “suffer harms such as the risk of physical, sexual, and emotional abuse at the hands of staff and peers, improperly executed and overused restraint and seclusion, inadequate treatment and supervision, and non-homelike environments that are often unsanitary and unsafe. These harms amount to acute safety concerns and have long-term effects, including suffering, trauma and even death.”
Prioritizing Profits Over Patients
How can this happen? Private residential treatment is big business. Facilities are marketed as nurturing, supportive solutions to challenging behavioral and mental health challenges. Websites are full of encouraging language such as “treating individuals with respect”, “operating with integrity”, “dedication of staff”, “provid[ing] a quality, effective and positive experience”, “patients are our top priority”, and “compassionate, understanding behavioral health support”.
It turns out much of this language is lip service, intended to keep shareholders happy, federal dollars flowing, and trusting, well-meaning parents in the dark so they keep sending their children for what they believe will be “compassionate, quality care.”
Because many RTFs are reimbursed by the government on a per patient basis, they are incentivized to cut costs and corners in order to reap big profits. The congressional report calls this out directly: “The risk of harm to children in RTFs is endemic to the operating model. The harms children in RTFs experienced are the direct, causal result of an operating model that incentivizes providers to optimize revenues and operating and profit margin.”
Unqualified, Overburdened, Undertrained Staff
Part of their cost-cutting measures involves those related to staffing. Whether that means hiring less qualified (and, therefore, cheaper) staff or not enough staff in relation to the number of patients, the resulting lack of appropriate personnel and supervision creates an environment ripe for abuse.
The congressional investigation found that “children spend the majority of their time supervised by…staff who are ill-equipped to address their complex behavioral health needs and, in some cases, children interact with staff who pose a direct threat to their wellbeing… In the worst of circumstances, children at RTFs suffer…sexual, physical, verbal, or emotional abuse at the hands of staff. Mistreatment is endemic to the conditions at RTFs.”
Whether it is the staff perpetrating these atrocities or creating an environment in which they are allowed to occur, unchecked, by others, the lack of investment in qualified employees is putting patients in danger. Maximizing profits at the expense of the most vulnerable patients is abhorrent and must be stopped.
Blaming the Victim – Again
It is an unfortunate reality that predators target the most vulnerable. It stands to reason, then, that RTFs should have a heightened duty of care, with more than the average protections in place to shield their vulnerable, often fragile patients. The congressional investigation found that, in reality, “horrific instances of sexual abuse persist unremediated inside RTFs.”
Many of these facilities have inadequate processes or policies in place to protect their patients or give them a voice. Sadly, because of their mental health or behavioral challenges, patients are frequently discounted as people, and their complaints against staff members or fellow patients go unheeded. In some instances, even multiple complaints about individuals or situations have not been followed up on, and accused staff are simply moved to another wing or another facility altogether without disciplinary action.
Scapegoating tactics abound. Accused staff members or peers will claim that sexual activity was consensual, that the victim was “promiscuous”, that they were “in a relationship”, or a host of other excuses that deflect blame away from themselves. And, facilities hide behind HIPAA as an excuse to keep these incidents quiet. Victims feel victimized all over again when their complaints are minimized or not taken seriously.
Denial: We’ve Seen This Playbook Before
Any attempts at remedial action fail to address the underlying culture of harm at RTFs. Despite being found in violation of state and federal regulations, RTFs in Massachusetts rely on the state’s lack of resources for follow-up to ignore demands to improve practices. This is very much the kind of playbook that we, at Shepard O’Donnell, have seen before from tobacco and asbestos companies: there is a well-known, well-documented, dangerous, and systemic problem, but the companies continue to profit and, therefore, use their substantial resources to fight in the courts and in the press to deny any wrongdoing.
And yet, despite their denials, asbestos manufacturers and tobacco companies regularly pay large financial settlements to victims. Isn’t it time RTFs were held to the same account?
Contact a Sexual Abuse Attorney
If you suffered sexual abuse at a RTF, know that it was not your fault. As this congressional report shows, abuse is rampant in many of these facilities. The companies that own and manage these facilities have allowed, even enabled, this abuse to take place and should be held financially accountable.
In our experience working with survivors of sexual abuse, we have learned how difficult it is, not only to come to terms with what happened to you, but also how difficult it is to come forward and tell your story. We are empathetic yet fierce defenders of your honor and promise to do everything in our power to hold sexual offenders and the institutions that employ them, accountable for the harm they’ve inflicted. When you’re ready, we are available for a confidential, no-obligation discussion about possible legal action.
