Science-Based Mental Health Care

Managed care also offers the potential to bring . . . science-based mental health care into the mental health system more quickly than traditional programs. . . . Many individual practitioners resist practice guidelines and scientific findings, preferring their own clinical experience, but managed care can put systems in place to measure performance and to enforce adherence to established standards.

But managed care also carries risks. Its emphasis on cost containment affects who offers mental health services, for how long, and of what type. MCOs encourage the use of clinicians who charge less per hour, preferring those with master’s degrees to those with doctorates and preferring those with doctor- ates to those with medical degrees. To further restrain costs, MCOs press clinicians to offer only short-term treatment of immediate problems rather than long-term treatment of underlying problems. As a result, therapists increasingly prescribe medications even if “talk therapies” might be more useful.

Managed care also has affected how mental disorders are diagnosed. One way managed care controls costs is by deciding in advance, based on data from past patients, how much and what type of care patients with specific diagnoses should receive. For this system to work, clinicians must assign a diagnosis to each patient. This in turn reinforces the medical model of mental illness and the idea that every person who seeks mental health services has a specific, diagnosable mental illness.

At the same time, to contain costs, MCOs have often opposed both new di- agnoses and any broadening of the criteria for existing diagnoses. For example, some MCOs deny treatment to individuals who have fewer than five symptoms on a depression checklist even if individuals’ listed symptoms are severe and even if they have other, unlisted symptoms.