
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: THURSDAY, July 20, 1995                   TAG: 9507200014
SECTION: EDITORIAL                    PAGE: A-10   EDITION: METRO 
SOURCE: DIANE KELLY
DATELINE:                                 LENGTH: Medium

MENTAL CARE FACES NEW CHALLENGES

AS MANAGED-care principles are being incorporated into public and private systems throughout the nation, providers and consumers of mental-health services face the very real risk that the quality of and access to care will be seriously diminished. In fact, some current forms of managed care have already established systems that are actually detrimental to the provision of mental-health services.

Many managed-care companies could be more accurately called ``managed cost'' companies due to the emphasis placed on administrative procedures and dollars rather than on improved access and quality of services. By creating hoops that the consumer must jump through before receiving treatment, managed care has made the system less user-friendly and has actually increased the stigma associated with mental illnesses.

Managed-care companies endorse a brief-treatment philosophy that is a distortion of the literature on effective mental-health care. Although it's clear that some problems can be effectively treated with a very few sessions, arbitrary across-the-board imposition of the brief-treatment standard becomes a major barrier to quality care, and creates the real possibility that patients may be dangerously undertreated.

Another major cause for concern is that most current managed-care companies operate outside the traditional mental-health care system, and thus escape legal regulations that apply either to insurance companies or to qualified mental-health providers. Serious concerns about conflict of interest can be raised about unregulated, for-profit agencies claiming to provide quality mental-health services even as their clear aim is to reduce costs and to increase profits. Who will manage the managed-care companies?

Managed care offers us the chance to rationally integrate various mental-health and rehabilitation services, and reduce fragmentation and cost-shifting. This emphasis on integration - integration of local mental-health services around real consumer needs, integration of health and mental-health care, integration of public and private sectors, and integration of funding streams for efficacy and accountability - could, over time, reduce stigma by truly mainstreaming mental-health services. Managed care may enable systems to create a rational balance between medication management, psychotherapy, and other supportive therapies. With a strong focus on outcome measurement, managed care gives us a means to measure and upgrade the quality of services.

Our health-care system must move away from the isolation and separate, unequal status currently accorded to mental illness.

We must take advantage of the opportunity offered by managed care to move toward parity in care while maintaining a system of psychiatric services that are clearly defined, goal-directed, supported by outcome research and challenged by public discussion.

Diane Kelly is executive director of Mental Health Association of Roanoke Valley, Inc.

by CNB