Emerging Trends In Mental Health Policy And Practice

PROLOGUE: As managed care matures in the general health care market, and the problems of accountability and patients' rights continue to elude policymakers, it is not surprising that the mental health community casts a reluctant eye on managed care while at the same time submitting to it. This paper by David Mechanic examines the issues—such as deinstitutionalization, parity in benefits, and integration with general health care—that make the mental health arena a particularly challenging but very attractive environment for care management. Mechanic reminds us that managed care is first and foremost a business strategy and that its implementation in the mental health arena requires a social contract between purchasers, mental health professionals, advocates, and the government to ensure that patients receive appropriate care. Ultimately, says Mechanic, the effectiveness of managed behavioral health care will be determined not just by the accountability of managed care organizations but also by the willingness of all players in the system to commit to change and be responsible for it. David Mechanic is the René Dubos University Professor of Behavioral Sciences and founding director of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University, in New Brunswick, New Jersey. He also directs the National Institute of Mental Health (NIMH) Center at Rutgers for Research on the Organization and Financing of Care for the Severely Mentally Ill. Mechanic is a member of the National Academy of Sciences, the American Academy of Arts and Sciences, and the Institute of Medicine. He is the author of Mental Health and Social Policy: The Emergence of Managed Care , 4th ed. (Allyn and Bacon, 1999). ABSTRACT: The continuing deinstitutionalization of patients in public mental hospitals and the growth of managed care are fundamentally altering mental health practice. Managed care provides opportunities for achieving parity of insurance coverage between mental and physical illness, but serious problems persist in integrating mental health, substance abuse, and general medical care and assuring an appropriate range of services and programs for persons with serious mental illness residing in community settings. Hospital and community care are poorly coordinated, and hospital care needs to be integrated into a more balanced system of services. Important new roles are emerging for purchasers, patient advocates, and mental health authorities.