What's Next for Managed Mental Health?

Managed care has dramatically changed mental health care in the United States.  Paperwork has skyrocketed as clinicians are required to fill out detailed forms to request additional sessions.  "Behavioral healthcare" companies have been born as mental health care has been "carved-out" of insurance plans to be managed separately.  What's in store for the future?  

Patients with co-occurring mental and physical disorders are poorly treated under the current system.

As research continues to blur the distinction between mind and body the current system begs for change.  Some believe that current trends - including the push toward parity legislation - will result in mental health benefits being reunited with (or "carved-in" to) benefits for physical health.  

Charles Kiesler wrote an article in the May 2000 edition of the American Psychologist predicting just such a scenario.  Kiesler stated that 88% of the population with mental health coverage now receive it through a "carve-out," that in the near future this will change, and that mental health care will be carved back into healthcare with the primary care physician being the "point-of-entry" for mental health services to be delivered.  

Does this mean that large mental health management companies such as Magellan, MCC, and United Behavioral Health will go away?  It probably means that some sort of shake-up or transformation will occur.   Patients with co-occurring mental and physical disorders are poorly treated under the current system.  Psychotherapy, biofeedback, and hypnosis can be helpful treatments for persons with chronic physical disorders, for example, but these services are often relegated to the "mental health" portion of a person's insurance coverage.  Substance abuse is often treated as a third category, separate from the mental and physical disorders sections.  We have seen the beginnings of this change as name changes occur - MCC is now CIGNA Behavioral Health, for example. 

Without going into too much detail concerning the reasons for carve-ins, the following is a summary of Kiesler's vision of the future....  

Next page A look at the Future >Page 1, 2

What do you think?

Reference:
Kiesler, Charles A. The next wave of change for psychology and mental health in the health care revolution. American Psychologist 2000 May Vol 55(5) 481-487.

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