Two current trends that affect the treatment of psychological disorders are managed care and deinstitutionalization.

Managed Care

Managed care is an arrangement in which an organization, such as a health maintenance organization (HMO), acts as an intermediary between a person seeking health care and a treatment provider. People buy insurance plans from HMOs and then pay only a small copayment each time they get healthcare services. Prior to managed care, health care was done through fee-for-service arrangements. In fee-for-service arrangements, people pay for any health care services they believe they need. They may then be reimbursed by insurance companies or government health care programs, such as Medicaid and Medicare.

The advantages of managed care are that consumers pay lower fees to providers and that money is not usually spent on medically unnecessary services.

Criticisms of Managed Care

Managed care systems have many critics who argue that HMOs compromise the quality of health care in the following ways:

  • Consumers are often denied treatment they need, or the length of treatment is inappropriately limited.
  • Managed care creates barriers to accessing health care services by requiring people to get referrals through their primary care providers or by authorizing only a small number of therapy sessions at a time.
  • Because of cost issues, the professionals who provide treatment are often less well-trained to treat severe disorders. For example, they may be counselors with master’s degrees rather than doctoral-level psychologists or psychiatrists.
  • Physicians might be required to prescribe older, less effective drugs rather than new drugs in order to keep costs down.
  • Clients’ confidentiality may be threatened because HMOs require therapists to disclose details about the clients’ problems in order to have treatment authorized.

The Community Mental Health Movement

In the past, people with psychological disorders typically received inpatient treatment at mental hospitals, or medical institutions that specialize in providing such treatment. In the 1950s, however, it began to be clear that mental hospitals often made psychological problems worse instead of better. Mental hospitals were very crowded and had few properly trained professionals, and they were often in less populated areas, giving patients little access to support from their friends and families.

In the 1950s, the community mental health movement started. This movement advocated treating people with psychological problems in their own communities, providing treatment through outpatient clinics, and preventing psychological disorders before they arose.

Because of the community mental health movement, deinstitutionalization became popular. Deinstitutionalization refers to providing treatment through community-based outpatient clinics rather than inpatient hospitals. Although people are still hospitalized for serious psychological problems, inpatient stays are usually relatively short and occur in psychiatric wings of general hospitals, rather than in mental hospitals far away from people’s communities.

  • Advantages of deinstitutionalization: Treatment at outpatient clinics is less costly than inpatient care and often just as effective. Also, people often prefer the freedom of community-based treatment to inpatient hospitals.
  • Disadvantages of deinstitutionalization: It has contributed to homelessness, since some people released from inpatient facilities have nowhere to go. Also, it has led to what is referred to as a “revolving door” population of chronically mentally ill people who are periodically hospitalized, released, and rehospitalized.

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