Across the United States transition support services are lacking. The adult system in particular will require major transformation to provide the service capacity that is needed to meet the current standards of transition service accessibility for young Americans with serious mental health conditions.
Rising costs. Treatable disorders. No treatment for many. High indirect expenses. The response to this contemporary set of circumstances has been managed mental health care. The transition from fee-for-service to managed behavioral health services has meant the industrialization of mental health care, an entirely new culture for providers, and a melding of the traditional public and private sectors. This article examines the evolution of managed behavioral healthcare from the point of view of how and why it occurred, what it means for providers, how it will impact on the seriously mentally ill, ways in which pay ors and providers can reach consensus on future directions, and the risks inherent in this process.He that will not apply new remedies must expect new evils; for time is the greatest innovator.-Francis BaconWhy start an exposition of managed mental health care with a quotation about time? Perhaps because the rapidity with which changes are occurring in this field means one must be cognizant of the date of any communication. This then is the summer of 1995, and any statements will reflect that vantage point. Perhaps, because managed care is really about managing time and, as one considers these remarks, one might remember that the focus of an earlier era, the patient appears to have left the foreground, to be replaced by resource management. And perhaps, because the changes wrought by time may be somewhat illusory, and one might cogitate about how much of what we now believe is novel, is actually repackaging rather than innovation.
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