Administration and Policy in Mental Health Vol. 27, No. 3, January 2000
IN THE LITERATURE
R. Sturm and R. Klap. Use of psychiatrists, psychologists, and master'slevel therapists in managed behavioral health care carve-out plans. Psychiatric Services, 50(4): 504-508, 1999. Outpatient claims data from a managed behavioral health company for 1996 were examined to determine the extent to which patients received services from different types of mental health care providers. Claims data were obtained from 75 plans with more than 600,000 members that were managed by one behavioral health organization. Data were examined by type of provider and diagnosis. Results found that after examining a total of 349,686 claims, doctoral-level psychologists accounted for most claims (33.4%), followed by psychiatrists (30.5%), social workers (19.8%), and other master's-level therapists (13.8%). Ninety-five percent of patients with a psychotic disorder and 86.2% of individuals with bipolar disorder were seen either by a psychiatrists alone or by a psychiatrist in combination with another provider. Because psychiatrists treated sicker patients, their proportion of patients treated (24.7%) was smaller than their proportion of all claims filed. Most patients (78.9%) saw only one type of provider. The results allay concerns that managed care shifts patients away from psychiatrists to doctoral-level psychologists and less expensive providers. The majority of patients with depressive disorders and almost all patients with psychotic disorders had contact with a psychiatrist.
S. Gabel and G.D. Oster. Mental health providers confronting organizational change: Process, problems, and strategies. Psychiatry, 61(4): 302-316, 1998. Under the influence of managed care and diminished funding, the mental health field is undergoing a major transformation. Existing mental health 157
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programs, department, and agencies are downsizing and restructuring to develop new types of service delivery systems. Organizations must change to survive; yet necessary and adaptive change may be resisted in numerous ways by providers whose reactions and behaviors may reduce the viability of their own programs and agencies. This paper explores various characteristics and reactions of mental health care professionals as they face great stress, professional devaluation, and necessary organizational change and restructuring. Adaptive and maladaptive patterns in response to potential organizational change are explored. The role of the leader in guiding and implementing programmatic changes and in dealing with denial and resistance is highlighted. Strategies to enhance the prospects for adaptive organizational change are offered.
M. Turner, M. Korman, M. Lumpkin, and C. Hughes. Mental health consumers as transitional aides: A bridge from the hospital to the community. Journal of Rehabilitation, 64(4): 35-39, 1998. The authors describe a consumer training project designed to facilitate a seamless transition between state hospital and community care for individuals with severe mental illness. A training protocol was developed and eight consumers were selected for training. Six mental health consumers completed the training and went on to be employed. Four of the consumers were employed by the community mental health center (CMHC) to work as transitional aides (TAs). The two remaining consumers were hired in the private sector. At the end of 2 years, five of the six TAs remain employed. Comparison of CMHC attendance for TA-assisted and non-assisted consumers indicated that the TA-assisted consumers had significantly higher attendance and lower drop-out rates than the non-assisted consumers. They also maintained contact with the CMHC for a longer time span than non-assisted consumers.
D. Callahan. Balancing efficiency and need in allocating resources to the care of persons with serious mental illness. Psychiatric Services, 50(5): 664666, 1999. The care of patients with serious mental illness, for whom a cure is unlikely and costs are high, is difficult to justify using ordinary standards of efficient resource allocation. The author examines the difficulties of using conventional utilitarian, cost-benefit, moral, and political arguments to justify allocation of resources to the care of persons with serious mental illness and offers an alternative approach to this problem based on the
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goals of medicine. Although care for persons with serious mental illness may not meet the usual standards of efficient health care spending, their treatment is justified by central and long-standing goals of medicine such as relief of pain and suffering and care of those who cannot be cured. This approach suggests that the idea of efficiency in health care spending should be adapted to the goals of medicine rather than making those goals adapt to the idea of efficiency.
