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This story was originally published by ProPublica.

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As the share of U.S. adults receiving mental health care treatment steadily grows, for-profit companies are playing an increasingly important role.

More than 40% of inpatient mental health beds were operated by for-profit entities as of 2021, according to unpublished data from Morgan Shields, an assistant professor at Washington University in St. Louis who studies quality in behavioral health care. That’s up from about 13% in 2010. (The number of mental health beds held relatively constant during that time.)

Experts tie this growth to provisions of the Affordable Care Act, which made mental health care an essential health benefit that all insurance plans are required to cover.

Before the law, millions of Americans lacked meaningful mental health care coverage by their insurers — if they had any coverage at all. That changed with the law’s passage in 2010. Three years later, the Obama administration went further, issuing rules that require plans to pay more for mental health care, and to pay for it as long as patients need it. (Some plans had previously imposed hard caps on the number of days they would cover.)

Wider access to and increased reimbursement of mental health services piqued the interest of for-profit corporations, said Eileen O’Grady, who until recently served as program director at the Private Equity Stakeholder Project, a nonprofit organization that researches the industry.

“Investors in for-profit entities see that as an opportunity to make money,” she said, “in a space that had not historically been seen as super profitable.”

Shields and other researchers have repeatedly flagged concerns about lower quality of care at mental health facilities owned by for-profit corporations, in part due to efforts to cut staff and reduce costs. Companies have defended the quality of care they provide.

ProPublica reported Monday that over 90 psychiatric hospitals across the country have violated the Emergency Medical Treatment and Labor Act in the past 15 years. [Truthout Editor’s Note: The Emergency Medical Treatment and Labor Act (EMTALA), enacted in 1986, requires hospitals to screen and stabilize all emergency patients regardless of whether they have insurance.] The vast majority of them — around 80% — are owned by for-profit corporations.

Yet only a handful have faced any consequences from either the U.S. Centers for Medicare and Medicaid Services or the inspector general of the Department of Health and Human Services, both of which are responsible for regulating the law. In the rare cases when hospitals have faced fines, the penalties have been trivial compared to the earnings of each for-profit hospital chain, the investigation found.

According to ProPublica’s analysis of CMS data, about half of all the hospitals cited were owned by just two corporations — Universal Health Services and Acadia Healthcare — which together operate hundreds of inpatient and outpatient behavioral health facilities, in addition to psychiatric hospitals. (UHS made nearly $16 billion in revenue last year, and Acadia collected more than $3........

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