Mission Unfulfilled: Potholes On The Road To Mental Health Parity

PROLOGUE: The rapid emergence of managed behavioral health care has transformed the treatment of the mentally ill in many ways that have been documented. But there are other dimensions that have been less well explored. In this lead paper prepared by David Mechanic and Donna McAlpine of Rutgers University, the most important (and disturbing) conclusion they reach is that as managed behavioral health care has grown to dominate treatment of the mentally ill, an increased democratization of that care has occurred. That is, individuals, however ill, have tended to receive a similar level of treatment. This approach obviously places at greater risk those patients suffering from the most serious forms of mental illness. Mechanic is the René Dubos University Professor of Behavioral Sciences at Rutgers University. He also directs the university's Institute for Health, Health Care Policy, and Aging Research. Mechanic's research and writing focus on the social aspects of health and health care, with a particular emphasis on patients' perspectives. He has been elected to membership in the National Academy of Sciences, the National Academy of Arts and Sciences, and the Institute of Medicine. Mechanic has written or edited twenty-four books and some 400 research papers, chapters, and other publications on subjects spanning health policy and research, medical sociology, and the behavioral sciences. McAlpine, who holds a master's degree in sociology from the University of Western Ontario, is a research associate at the Rutgers institute. She is the coauthor of a number of influential papers on managed care and other topics in medical sociology. ABSTRACT: Managed care holds the promise of facilitating parity between general medical care and alcohol, drug, and mental health care by reducing expenditures, even while expanding benefits. Limitations in our knowledge of variations in needs and treatment standards for substance use and psychiatric illnesses make such disorders an easy target for management. Costs for behavioral health care services have been reduced ata faster pace than has been the case for general medical care costs. The most severely ill face the potential burdens of managed care as access and intensity of care become more uniform across patient populations.