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Cut Mental Health Care With Care


Editorials

CUT MENTAL-HEALTH CARE WITH CARE

Separation of work and private lives is a traditional American ideal. Yet many employers found in the 1980s that they could not ignore the emotional or substance-abuse problems of their workers and their families without incurring big costs. That led many companies to broaden their mental-health benefits.

But while workers gained from better coverage, employers saw their mental-health-care costs explode, in part because unethical providers were able to wring the maximum payments out of the system. In self-defense, many corporations have wholeheartedly embraced managed care for mental health. The new model stresses mental-health care as a short-term response to a temporary crisis, such as depression. That's far different from the open-ended care of traditional therapy (page 66).

But now, corporations need to take a closer look at how they are managing their mental-health plans. There's no question that short-term therapy saves money. Unfortunately, managed-care companies often can have a financial incentive to limit unreasonably the length of care. Moreover, by demanding quick fixes, some outfits interfere with the trusting relationship that's needed for therapy to work. And almost by definition, the people who need mental-health care are grappling with problems that fill them with shame and hinder their ability to demand better treatment.

For liability reasons, as well as the benefit they get from a well-adjusted workforce, employers can't afford to be satisfied with cost-cutting alone. These systems can work if employers require that managed-care companies meet quality standards and respect employee privacy. And as Congress considers broader health reform, it should insist on mental health programs that put quality first and allow well-trained providers to give individual patients the care they need.


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