Frameworks for understanding value discrepancies and ethical dilemmas in managed mental health for social work in the United States

The purpose of this article is to explore the ethical dilemmas social workers face as they grapple with the day-to-day effects of managed mental health care organizations (MMHOs). It will explore the dilemmas created by the con íãicts that emerge from the disparate values that exist in the profession of social work and in MMHOs. It is important to examine this discrepancy because MMHOs are becoming increasingly in íãuential in affecting mental health services in the United States, with often deleterious consequences for mental health consumers (Backlar, 1996; Dumont, 1996; Geller, 1996; Hall, 1996; Karger and Stoesz, 1998; Jellinek and Nurcombe, 1993; Miller, 1994). While managed care is not yet prevalent in many countries of the world, globalization and the demands of the World Bank and the International Monetary Fund have led to the privatization of many social and economic institutions. It is likely that managed care will become increasingly called upon to act as a tool in the efforts of governments as they grapple with privatization. This topic will become more important as managed care becomes a permanent part of the social service delivery landscape internation- ally and as social work values continue to clash with those of managed care.