At the crossroads: Managed mental health care, the ethics code, and ethnic minorities.

Abstract

Mental health clinicians are facing an increasing number of ethical problems related to the delivery of managed mental health care services to ethnic minorities. The authors argue that (a) economic pressures have led to the development of the managed health care movement; (b) the combination of such economic pressures and the development of that managed care movement have influenced the promulgated ethical standards of the American Psychological Association; and (c) those influences may have a negative impact on the mental health services available to ethnic minority individuals and communities. The authors review some of the specific potential threats to mental health services for minorities in the face of such health management policy and psychologists' professional standards.

International Perspectives on Psychotherapy

“…Some therapists have responded by offering briefer models of psychotherapy, while others have opted out of the managed care system and do not directly work with any third party insurers. Therapists who have opted out of working with third party insurers are more likely to have more experience, creating inequities in access to quality mental healthcare (La Roche & Turner, 2002).…”

Quality Improvement in Behavioral Health

“…Moreover, providers have expressed concerns that QI programs will be used to punish clinicians by linking pay with performance Valenstein et al, 2004 ), and as an unintended consequence lead providers to treat only the more "easily treatable" patients (Bachman, 2006 ). This in turn could increase health disparities in racial/ethnic minority and other underserved populations who would then fail to receive much needed care (Casalino et al, 2007 ;La Roche & Turner, 2002 ). Lastly, given the heterogeneity of clinical settings and patient samples, the variety of diagnoses and presenting problems, and the diversity of theoretical orientations and therapeutic approaches, developing a valid, reliable, and feasible QI program seems a daunting, if not impossible, task.…”

Psychology's response to managed care.

“…As we know, there is a long and well-documented history of abuse and neglect of ethnic minorities within our mental health system (Satcher, 1999). La Roche and Turner (2002) warn that, if health policies are not crafted in a careful, sensitive, and appropriate manner, there is a significant risk that this history of abuse and neglect will repeat itself. They emphasize that "those with the least power in the policy decision making are frequently the most vulnerable to any adverse (though possibly unforeseen) effects" (p. 188).…”