"People do know what to do to get services," he said. "But if a clinician is savvy and smart enough, they'll know if a person is doing it to angle their way in the door."
"I was like, well, I really don't suffer from this," he said. "She was like, you've got to suffer from something, you've got to be on some type of psych meds to be in the program."
Lubold, who was addicted to heroin and prescription pills, had doubts about meeting with the psychiatrist. "But they found that I did suffer from depression," he said.
Asked about allegations that BBH staff members have guided patients in what to say, Hathaway wrote, "Any staff providing such advice would be immediately released from employment." He noted that patients mislead clinicians: "It happens and challenges caregivers in all segments of the health care industry."
And, it is not uncommon for people with mental illness to be in denial, he wrote.
Anthony Tazewell, 48, went to BBH after hearing good reviews on the street. "I did not know how to stay clean," he said. "I had a mental problem. I was diagnosed with severe depression. I didn't know that until I went to BBH."
He was put on Lexapro. It is one of the more commonly prescribed drugs at BBH along with Seroquel, an antipsychotic and sleep aid.
Seroquel is "a big gun," said Dr. Christoph Correll of the Feinstein Institute for Medical Research in Manhasset, N.Y. A weeks-long course "can have potential side effects, like weight gain and metabolic issues that could even be associated with diabetes in the future if the medication is continued for longer times."
A 30-day supply of Seroquel costs the state $285. Over the past six years, state health department records show that Scotto and a BBH colleague wrote more than 6,000 Seroquel scripts.
A means to an end?
Lubold, Niagado and Tazewell told The Sun they were diagnosed with the same mental illness: major depression. Elana Bouldin, a mental health coordinator at BBH in 2007 and 2008 until being laid off, recalled one patient after another filing into therapy with that assessment.
But "once they got detoxed, a lot of times they were feeling better," said Bouldin, who facilitated group sessions and met individually with patients. That made her wonder whether they had a separate psychiatric disorder, much less one requiring hours of therapy day after day.
Most psychiatric diagnoses at BBH fall into two categories: major depression and bipolar disorder. Major depression is a disabling, often chronic, illness that makes it hard to work, sleep and eat, according to the National Institute of Mental Health. Bipolar disorder causes "shifts in a person's mood, energy and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe."
Carol Agurs, a licensed clinical social worker who ran group therapy sessions on weekends at BBH in 2007 and 2008, thought many patients belonged but had doubts about others.
"Were some of them living with a true, treatable psychiatric disorder — a bipolar disorder, a major depressive disorder? I would question that," said Agurs, 53, who left BBH to teach. "Because a lot of times when you have people coming off crack, that will mimic depression, that will mimic a sadness at the bottom of the barrel."
Hepburn of the Mental Hygiene Administration contends that the misdiagnosis of mental conditions in addicts is "a national problem."
"If you go to any emergency room in the city or the state you'll find the same thing," he said. "Addicts are frequently given a diagnosis that's an affective disorder — by that I mean, either depression or bipolar disorder. … It's easier to get somebody into services if they have a psychiatric problem."
Because of the stigma that mental illness can carry and the potential side effects of psychiatric medication, Hepburn rejects the notion that such practice is a justifiable means to a desirable end: more drug treatment for more addicts.