Managed Mental Health Care

Timothy B. McCall, M.D.

To offer employers competitive premiums, HMOs have made broad cuts in their services—slashing everything from hospital stays to the use of high-tech tests. But according to Marketplace medical commentator Dr. Timothy McCall, no area of has taken a bigger hit than the treatment of psychiatric problems.

According to a just-released study, mental health care benefits have been cut by more than 50 percent in the last 10 years. In particular, HMOs along with employers have been reluctant to pay the cost of ongoing psychotherapy. Even patients with serious disorders that stem from such things as childhood sexual abuse are being limited to just a few visits. That’s if they’re seen by a therapist at all.

This is perhaps best captured by a recent cartoon labeled “Single Session Therapy.” In it the doctor is slapping a patient across the face and screaming “Snap Out of It!”

The only area of mental health coverage that employers and HMOs seem interested in funding is drug therapy. They’d rather just throw Prozac—or better yet some generic substitute costing pennies a pill--at your problem. New anti-depressants have proven to be effective. What’s been lost, though, is that many people still need and benefit from psychotherapy.

Also, given the financial incentives against referring to specialists, primary care doctors are managing more and more patients with psychiatric problems themselves. Past studies have shown they don’t do such a great job of it. Primary care physicians recognize depression far less often than mental health specialists and treat it less appropriately.

Two recent studies document just how bad things are. One found that fewer than half of patients with schizophrenia received proper treatment. The other discovered that only 44 percent of depressed heart patients got any treatment for their depression at all.

And the situation is getting worse as HMOs continue to ratchet down mental health services. Unfortunately, the new federal law mandating parity in mental health care coverage doesn’t solve the problem. That’s because any treatment--even if it’s technically covered by your plan--still needs to be approved.

And there’s the rub. If what you need most is therapy or hospitalization, you may have a very hard time getting the go-ahead. According to one local psychologist, the credo of new managed mental health care industry is a lot like one old television theme song: “Drug ‘em up. Move ‘em out. Rawhide!”

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