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PubMed1989

Iatrogenic factors in "managed" psychotherapy.

The clinical implications of the "case-manager" system are explored through a detailed case presentation. It is demonstrated that the introduction of a third person into the therapeutic relationship compromises the therapeutic alliance and the transference. Under such conditions psychotherapy is impossible.

Adult↗
PubMed1995

Meeting managed care: An identity and value crisis for therapists.

The micromanagement of the psychotherapy enterprise by private insurance interests has placed clinicians in new and unfamiliar roles in relation to their patients and to the professional marketplace. The value systems compatible with most managed care organizations are divergent from those held by an earlier generation of mental health professionals.

Attitude of Health Personnel↗
PubMed1975

Family mental health maintenance: a new approach to primary prevention.

The authors describe an approach to primary prevention in which indirect services are redefined to include community services aimed at promoting mental health and preventing emotional and mental disorders. At the Peninsula Hospital Community Mental Health Center such services are family-focused and include consultation, education, collaboration with other agencies, and early intervention with children and families with special needs. The authors describe some of the programs that have been developed and discuss how mental health Centers can conceivably, under contract, develop such community services for health maintenance organizations and other prepayment plans that provide comprehensive health maintenance and medical care.

Adolescent↗
PubMed1977

Obtaining state legislation for insurance coverage of day hospitalization.

Whether a patient receives treatment in a 24-hour inpatient setting or a less restrictive day hospital program often depends strongly on what kinds of care the patient's health insurance policy covers. In 1974 advocates of partial hospitalization programs in Maryland began working for a state law requiring third-party payers to provide day hospital benefits to all policyholders. After realizing that the bill as drafted would not pass the legislature, its advocates negotiated with insurance carriers, legislators, and others. The bill was rewritten so that day hospital coverage must be offered as an option in group policies only, and at an adjusted premium if necessary. It was enacted into law in 1976 and became effective in January 1977.

Day Care, Medical↗
PubMed1981

The National Plan for the Chronically Mentally Ill: a review of financing proposals.

In this, a companion piece to the preceding article, the author summarizes and examines the financing issues and recommendations set forth in the National Plan for the Chronically Mentally Ill. The major federal programs that provide assistance to chronic patients are described briefly. Sixteen proposed incremental reforms designed to fill gaps in the existing service system are listed and discussed; nine involve changes in the Medicaid program. The author also considers the options to go beyond incremental changes toward the establishment of a comprehensive program focused specifically on the needs of the chronically mentally ill. He discusses the advantages and drawbacks of three methods of organizing financing of mental health services that are described in the National Plan--a structured services program, a benefit-voucher program, and a cash transfer program.

Chronic Disease↗
PubMed1981

The impact of mental health services on medical care utilization: economic and organizational implications.

A wealth of studies support the assertion that patients seen by medical doctors for physical complaints can often be helped by psychotherapeutic intervention. Many physical ailments have been linked to emotional problems, and practitioners are beginning to understand that emotional and physical health are highly interrelated. Even very brief mental health intervention can reduce the number of visits for medical care, the studies show. Despite some obvious methodological shortcomings, past studies and literature reviews strongly endorse the development of a closer working relationship between mental health and physical health professionals. The need for extensive additional research with sound methodological design is discussed. The economic and organizational implications of this relationship are also explored from the perspectives of physical and mental health practitioners, patients, group health plans, and third-party payers.

Adolescent↗
PubMed1982

Encouraging third-party coverage of partial hospitals.

Despite the proven clinical effectiveness and cost-effectiveness of partial hospitals programs, any third-party insurers still refuse to offer coverage of their services. A number of clinical, administrative, and fiscal issues involving current partial hospital programming and the health care system in general have led to this difficulty. The author outlines these barriers, which include concerns about lack of cost accountability, lack of financial incentive to third parties, and lack of consumer interest, and makes specific recommendations on pursuing coverage of partial hospital programs. He urges a redefinition of the scope of partial hospital services and the development of detailed standards of treatment as prerequisites to pursuing third-party coverage.

Day Care, Medical↗
PubMed1982

Partial hospitalization: state of the art.

While partial hospitalization as a treatment modality has existed since the 1930s it has been only recently begun to gain widespread attention. The attempts at defining partial hospitalization are traced to the current standards and guidelines. The authors review studies of efficacy and cost-effectiveness and find that partial hospitalization almost invariably compares favorably with inpatient treatment. There are a number of factors militating against increased use of the modality, including haziness in the definitions of goals and target populations, prejudice among clinicians and patients, institutions' resistance to relinquishing beds, and difficulty in establishing third-party reimbursement. The state of the art in partial hospitalization is an attempt to translate face-value validity into an acceptable and fundable alternative to inpatient treatment. The authors conclude that, despite the relatively small growth of programs nationwide and the reluctance of third-party payers to reimburse for the modality, partial hospitalization has an enduring role as a treatment modality.

Ambulatory Care↗
PubMed1983

American mental health policy: changing directions in the 80s.

Mental health programs always reflect changes in the political environment. For instance, under the Carter administration the President's Commission on Mental Health displayed great interest in reforming the community mental health center service system, expanding mental health research, and developing a new national health insurance package. In contrast, the Reagan administration has sought to minimize the federal government's role in operating many health programs. The authors examine the repercussions that block grants and reduced federal funds will have on mental health research, training, and insurance policies. Competition for funding between community mental health centers and state hospitals, future strategies for mental health services, and fundamental policy questions are also discussed.

Community Mental Health Services↗