The mental health care revolution: Will psychology survive?

Abstract

Managed mental health care, which encompasses a wide variety of approaches, is a response to precipitous increases in health care expenditures, particularly as they relate to mental health care. The shift from what seemed certain to become a national health insurance program only 15 years ago to the profit-driven corporate health care industry of today is truly revolutionary. These profound changes are beginning to have a major impact on the independent practices of psychologists. In this article, psychologist practitioners are exhorted to recognize this new development in the marketplace. Data are cited that show the rapid shift from free choice care to various forms of managed care, and practitioners are urged to participate in shaping the changes that are now in process in order to develop a humane and effective system of mental health care.

Ethical dilemmas encountered by members of the American Psychological Association: A national survey.

“…The Ethical Principles of Psychologists (APA, 1990) and the current draft revision ("Draft," 1991) address many of these issues, such as organizational demands that are in conflict with the principles, the relationship of financial arrangements to a client's best interests, and prolonging a professional relationship beyond the point that it benefits the consumer. However, the growing influence and prevalence of third-party payment sources, from traditional insurance to HMOs and EAPs, seem to have intensified the need for explicit ethical standards that address more directly, realistically, and helpfully the dilemmas created by these payment sources (see, e.g., Cummings & Duhl, 1987;DeLeon, VandenBos, & Kraut, 1986;Dorken & DeLeon, 1986;Kiesler & Morton, 1988a, 1988bPope, 1990a;Zimet, 1989). Psychologists who find themselves working for organizations such as HMOs and for patients served by those organizations may be facing conflicts parallel to those faced by industrial-organizational psychologists.…”

Supply Dynamics of the Mental Health Workforce: Implications for Health Policy

“…All mental health workers are concerned about the growing impact of managed care, both on certain specialty groups (Zimet 1989;Bennett 1993) and on the quality of mental health care for persons with mental illness, particularly ethnic minorities, the Medicaid population, and the elderly. Within the framework of managed care, mental health services can be delivered either by a full-service managed care organization (MCO) or by a managed behavioral health care organization, or "carve-out."…”

The Case Against Licensing Health Professionals

“…Professional psychology has achieved the dream of parity with psychiatry, but at the cost Rogers predicted-licensing has defined acceptability in professional psychology. Professional psychology is increasingly spoken of as a health profession (Austad & Hoyt, 1992;Fowler, 1990;Kiesler & Morton, 1988) and has public and private credentialing for health care providers (Zimet, 1989). Most areas of thirdparty reimbursable practice bar psychologists without specific health credentials and ignore nonpsychologist providers (Cummings, 1990).…”