The brutal deaths of Rob Reiner and his wife Michele, allegedly at the hands of their 32-year-old son Nick, tragically and dramatically brings the systemic failures of the current treatment practices and approaches for substance abuse, mental health and homelessness into stark relief.
In a 2016 People Magazine[i] article Nick stated that his first trip to rehab was at age 15 (2008), returning 17 times with sporadic periods of homelessness between trips.
Since the publication of the article it has been reported Nick had numerous further stints in treatment, both for Substance Use Disorder (SUD) and mental health issues (principally schizophrenia), and was placed in a mental health conservatorship[ii] for a year in 2020. In interviews Nick has been candid about his mental health struggles, illicit drug use, including Crystal Meth[iii] and homelessness.
With over 40 years in recovery and one of 14 Certified Mental Health Recovery Peer Specialists (CMHRPS)[iv] in California I know - and have known - many Nick Reiners’ as well as their families and loved ones who struggle and suffer as well trying to comprehend their often-baffling behavior, consistently questionable decisions, the lies and manipulations coupled with the frustration of dealing with a wholly inadequate system in seeking help for them.
For most initial contact when seeking help is routinely conciliatory and accommodating in tone while your information is gathered for placement. But once admitted to a SUD treatment or a mental health facility the realities of the current system become painfully apparent. Try to imagine (I am sure many reading this won’t have to) dealing with someone in a call center, often in another country[v] working from a carefully worded script, making decisions on the length, level and type of care you, your child or loved one receives.
Having personally lobbied for clients who were making real headway, only to have further treatment denied based on inflexible metrics and cold financial benchmarks, knowing the possible real-world consequences, the frustration is impossible to convey with mere words.
Then there is the nightmare call from a parent whose child “completed” treatment and returned home, often with the best of intentions but lacking an integrated Aftercare plan, within weeks, sometimes days succumbs to an overdose. As you can rightly imagine, words fail.
Additionally individuals who “AMA” (leave Against Medical Advice) often “disappear” into a shadow world of no questions asked hotels/motels, homeless encampments, or Skid Row[vi]. Nick chose this path, by his own accounts, numerous times.
Trying to explain to someone that their child or loved one has “left” and legally you can provide no information due to HIPAA (Health Insurance Portability and Accountability Act) regulations; saying this is a hard conversation doesn’t come close to the reality of it.
The true horror begins though when they fall prey to rehab “body brokers”[vii] who stalk this shadow world. For brokers these individuals are gold since upon relapse and reentry into treatment their insurance payout clock resets.
Brokers are essentially human traffickers who are paid finders fees from unethical facilities to locate “relapsers” and encourage (i.e. pay) them to return to treatment. Though costs vary, the average in California for a 30-day Residential Rehab is over $50,000[viii]. Once the facility bills their insurance and gets paid, the broker receives an additional large kick back (thousands of dollars) for their efforts.
Routinely the individual will leave treatment again, relapses (often with the assistance of the broker), and the cycle repeats. Body brokers have been known as well to fraudulently purchase insurance for individuals to perpetuate this horrific but incredibly lucrative illegal practice.
I worked with many on their 4th, 5th or more times around this block. One young man I worked with was on his 41st round of treatment. He was an expert at the game and lured other clients in to it. In 2023 one of the owners[ix] of a facility this young man cycled through was arrested for utilizing body brokers and money laundering and is currently incarcerated in a Federal Penitentiary. HIPAA must be amended to more easily identify these individuals and facilities for prosecution.
We may never know if Nick Reiner fell into this dark circus, but he would have been a very tempting target. The Reiner’s case demonstrates, by all accounts, that Nick received the best treatment and support available, and though we will probably never know with certainty all that transpired, like so many Nick fell through the holes and his parents paid the price emotionally for years watching their son struggle despite their best efforts, and if accounts are true, finally with their lives.
Though the Government does occasionally hold someone’s feet to the fire for malfeasance, fraud is rampant. Every year from the local to the Federal level BILLIONS of dollars are spent on addiction, homelessness and mental health and the results are, if I am being kind, lackluster at best to downright tragic. Since 2019 California alone has spent over 24 BILLION[x] on these issues which has accomplished precious little while the funds are mostly unaccounted for.
Additionally since the passage of the Affordable Care Act (ACA) Healthcare Providers profit margins have increased by a reported 230%[xi] yet coverage and resources, particularly for this population, though still substantial, have diminished.
Today’s current built-in limitations and hurdles, of both Healthcare Providers and Governmental agencies, coupled with a lack of any real cohesion between the professional and non-professional treatment communities perpetuates the lack of any truly effective and AFFORDABLE Aftercare for sufferers and their families after a SUD treatment cycle or mental health hospital stay.
Combine this with the overall failure in honestly addressing the realities of the homeless population, which is largely composed of the addicted and mentally ill, while adding in the unfortunate stigma[xii] toward addiction and mental illness that is alive and well and a true picture begins to take shape.
A new and innovative paradigm is required. A fresh but uncomfortable look at the current state of professional treatment practices, the failure of truly integrating the real-world experience of those living full lives free of active substance abuse and untethered mental illness and homelessness into a new, all-encompassing approach.
When you change the way you look at things, the things you look at change is as true today as ever.
In conclusion: the resources for change are available now, the problems lie in the bureaucracies that manages them, the bad actors preying on this population, the current regulations and restrictions which often do more harm than good, the one-dimensional approaches, in both professional and real world recovery, and the lack of any real coordination between professional engagement and those demonstrating real world recovery must all be addressed.
Instead of one-size-fits-all metrics, arbitrary limits and counterproductive restrictions, the focus must be on the individual’s needs, bringing to bear all the tools and approaches available today while effectively utilizing the deeply experienced individuals in both long-term SUD and mental health recovery who stand ready to be of service since it is an integral aspect of their continued success. As the saying goes “To keep it you have to give it away.”
But as dire as it is, there is hope. Habilitat[xiii] in Hawaii created a model based on long-term engagement (i.e. Aftercare) teaching people to live beyond their addictions and homelessness which has worked with thousands since 1971 and recently the Grammy Award winning artist Jelly Roll[xiv] (Jason DeFord) was instrumental in opening the first 100% free recovery and medical center for the homeless in Nashville which provides 200 beds and is privately funded, as is Habilitat.
As a society the hope is that the Reiner tragedy is the spark which ignites real conversation with a no-holds-barred assessment fomenting concrete actions and positive change. The question is, will it?
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I am the creator of Miracles Of Recovery which is a blueprint for an honest dialogue concerning addiction, mental health and homelessness. I am one of 14 CCAPP Certified Mental Health Recovery Peer Specialists (CMHRPS) in California having over 40 years’ experience in personal recovery. I have worked with individuals from all walks and strata of society, from Park Avenue to park benches, from the instantly recognizable to the forgotten and lost, and have dealt with all manner of governmental entities, agencies and healthcare providers (both public and private) intimately familiar with the often one-dimensional “solutions” and the insidious stigma and curious prejudices surrounding treatment, recovery processes and homelessness found in both the professional and “real world” recovery and mental health communities.
[v] https://mybillingguy.com/the-end-of-offshore-billing-how-us-practices-are-reclaiming-revenue-and-control/
[ix] https://www.justice.gov/usao-cdca/pr/hollywood-hills-man-sentenced-nearly-3-12-years-federal-prison-paying-nearly-29
[x] https://www.usatoday.com/story/news/nation/2024/04/11/california-homelessness-programs-audit-billions/73282144007/
[xi] https://truthout.org/articles/top-5-us-health-insurers-annual-profits-jumped-230-percent-since-acas-passage/
