Challenges of a Managed Care Approach to Mental Health Care

Congress declared the 1990s the "decade of the brain," concentrating attention and research efforts on mental illness, as well as other areas connected with the brain. Nevertheless, the issues of mental illness still presents major challenges to patients, those who care for them and those who finance that care. According to an article in the American Journal of Psychiatry written by Robert A. Bailey, M.D., the implications of cost on continuity of good care can be detrimental.

Insurance

• Of the 180 million Americans who have medical insurance, 75 percent of them have some kind of managed mental health care plan written into the policy. Managed care has been around for a long time, but its use has increased since the 1980s. Employers sign a contract with one of the companies offering to manage care for their employees. One of the main aims of managed care is to reduce costs. But the cost of mental health care is notoriously expensive as it is not usually of short duration. Critics of the managed mental health care approach argue that the advice and care given is often governed primarily by cost.

Advice

• The initial advice, under the managed care plan, is often over the telephone. It is very difficult to properly assess a person's mental state in this way, particularly if the patient is unknown to the person on the other end of the telephone. There is a danger that people who require hospitalization will not be allowed this, and that time limits will be imposed on therapy sessions.

Status

• The managed mental health programs can add to the worries of the person with a mental illness. Many report a deterioration in their insurance status if they have been treated for a mental illness. This is coupled with the high rates of unemployment amongst people who have had a mental illness. Many patients worry that they will lose their jobs, particularly if they have been off sick for periods of time. In addition to this, patients also worry about their confidentiality as insurance companies ask for more details of their illnesses.