Personal, practical, and professional issues in providing managed mental health care: a discussion for new psychotherapists

Written by a former corporate manager pursuing counseling as a 2nd career, this article offers pointed views on managed mental health. Values of practitioners that are a mismatch for managed care are noted, and more specific disadvantages and advantages are examined. Loss of client confidentiality is addressed and procedures and technologies for its reclamation are noted. Negative effects on therapy are acknowledged and potential for better accountability and research are pointed out. Economic disadvantages of a small provider's practice as well as opportunities for creating new value and additional income are reviewed. The relatively sudden emergence of managed care is credited with a natural time lag preceding regulatory responses. Acknowledging that most new practitioners have little choice about the clients they serve, the article concludes that it would be shortsighted to rule managed care out of one's practice.     

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

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.     

Conflict across organizational boundaries: managed care organizations versus health care providers

This research examined conflicts that occur across organizational boundaries, specifically between managed care organizations and health care providers. Using boundary spanning theory as a framework, the authors identified 3 factors in the 1st study (30 interviews) that influence this conflict: (a) organizational power, (b) personal status differences of the individuals handling the conflict, and (c) their previous interactions. These factors affected the individuals' behavioral responses or emotions, specifically anger. After developing hypotheses, the authors tested them in a 2nd study using 109 conflict incidents drawn from 9 different managed care organizations. The results revealed that organizational power affects behavioral responses, whereas status differences and previous negative interactions affect emotions.     

Experiences of the health care delivery system in a rural South African setting

This exploratory study aimed to examine health care provider work-related experiences in a rural South African context. Participants were a convenient sample of 12 medical practitioners (private sector = 55%). The practitioners responded to an open-ended question on their health care delivery-related experiences. Thematic analysis of the data revealed that the medical officers experienced both care provider fatigue and satisfaction from their work roles. Experiences of care provider fatigue were characterised by stress, anxiety, hopelessness, depression, burnout, frustration, and anger. Care provider satisfaction was associated with happiness, ability to cope, security, conscience, and commitment. Job retention and satisfaction of the health care providers were dependent on material and manpower resourcing of health services.     

Eavesdropping on the 50-minute hour: managed mental health care and confidentiality

This article discusses managed care, recent case law developments, and the legal basis of confidentiality in the patient-therapist relationship. It discusses how managed care intrudes into the confidential treatment relationship with prospective and retrospective utilization reviews. Some of the areas adversely impacted include public policy, the patient-therapist relationship, and informed consent. In order to be a program in the interest of patients and not simply cost containment, managed care must accommodate patients' reasonable expectations of confidentiality. Suggestions are delineated for the protection of confidentiality by managed care, including expanding the duty of confidentiality to managed care, obligating managed care to secure patients' informational privacy, obtaining informed consent to disclose as little information as necessary, and involving the patient in the cost containment and quality assurance process.     

Managed care, medical privacy, and the paradigm of consent

The market success of managed health plans in the 1990s is bringing to medicine the easy availability of electronically stored information that is characteristic of the securities and consumer credit industries. Protection for medical confidentiality, however, has not kept pace with this information revolution. Employers, the managed care industry, and legal and ethics commentators frequently look to the concept of informed consent to justify particular uses of health information, but the elastic use of informed consent as a way of responding to managed care health plans' disclosure of information to third parties fails to address underlying questions involving substantive value choices.     

Group psychotherapy of substance abuse in the era of managed mental health care

The changes in health-care financing that have taken place over the last decade have spurred interest in finding innovative ways of delivering services at manageable cost levels. It comes as no surprise that increased interest and research have focused on group therapies as a major vehicle for reaching large numbers of people in need of psychological care that is brief, effective, and cost-efficient. More specifically, practitioners in the field of substance abuse have long recognized the value of group experiences as an integral part of the recovery and rehabilitative process. The influence of managed care to contain costs has added new incentives to expand the existing knowledge base in group treatment of addictions to comply with reduced funding and time constraints.     

Justifying public health surveillance: basic interests, unreasonable exercise, and privacy

Surveillance plays a crucial role in public health and for obvious reasons conflicts with individual privacy. This article argues that the predominant approach to the conflict--relying on a conceptual distinction between research and practice--is problematic and then offers an alternative. It outlines a basic interests approach to public health measures and an unreasonable exercise argument, which sets forth conditions under which individuals may justifiably exercise individual privacy claims that conflict with public health goals. The view articulated is compatible with a broad range of conceptions of the value of health.     

A survey of mental health care provider's and managed care organization attitudes toward, familiarity with, and use of group interventions

Managed Care has had a significant impact on delivery systems for mental health services. Direct and indirect persuasion to provide more cost-effective treatments has been one consequence. The cost-saving qualities and the effectiveness of group interventions have produced clear expectations for an increased use of therapy groups. This study compared perceptions and uses of group treatments on a national sample of managed care organizations and mental health providers. Because group psychotherapy encompasses such a broad definition, five specific types of group interventions were defined: problem-focused homogenous, process-oriented heterogeneous, psycho-educational, self-help, and short-term groups. Implications of differences and similarities between directors of managed care organizations and treatment providers are examined and discussed across five response categories (familiarity/training, perceived effectiveness, likelihood of reimbursement/referral, daily use, and expectation for future use).     

Human factors engineering in computerized mental health care delivery

There has been strong clinical resistance to the use of automation in mental health. At least part of the resistance may be due to the researcher’s failure to understand the psychological factors involved in the human-computer relationship. This paper reviews human factors research as it may be related to computerized systems in mental health. Human factors considerations are specifically applied to: design and implementation of computer systems, patient-computer interaction, mental health staff-computer interaction, and computer output.     

Sociotechnical systems in health care: a field experiment.

This article describes an intervention that employed sociotechnical systems (STS) analysis in the laboratory of a major health care institution in the Midwest. The analysis was performed on two departments of the laboratory to determine opportunities for improving effectiveness, facilitating the introduction of new technology, and enhancing the work experience of technologists. The authors measured the results of the intervention by conducting a survey of technologists before and after the change effort and through follow-up interviews with a sample of physicians, supervisors, and technologists. The intervention did not achieve the results intended, and the authors present their explanation for why this occurred and suggest implications and recommendations for future STS applications to health care settings.