First Steps toward Mental Health-Care Reform

By Welch, Bryant L. | National Forum, Summer 1993 | Go to article overview

First Steps toward Mental Health-Care Reform


Welch, Bryant L., National Forum


There are two long-standing structural anomalies wasting millions of badly needed dollars in our mental-health system. First, we are needlessly using very expensive hospital-based treatment for significant numbers of patients who, research shows, could be better treated in outpatient settings.

All documented evidence shows that recent increases in mental health-care costs have occurred only in inpatient alcohol and drug treatment and in inpatient adolescent care. At the same time, research now concludes that nearly 50 percent of these patients could be treated more effectively in outpatient settings.

Why aren't these individuals treated in outpatient settings? The reason is based on current economic and insurance incentives. First, in 1984 when the Medicare Prospective Payment Diagnosis Related Groups system was established, it was not applied to psychiatric units or psychiatric hospitals. As a result, entrepreneurial hospital dollars were directed into purely psychiatric facilities, providing a doubling of the number of such facilities between 1984 and 1988. This, of course, led to much greater "provider demand" for patients.

Second, hospital-based treatment is covered often at 100 percent reimbursement with little or no expense to the beneficiary, while outpatient benefits are extremely limited and require significant sharing of costs. What this poses to a family is a decision of whether to keep a disturbed family member at home with outpatient treatment or, instead, to put the patient in a hospital-giving the family respite and eliminating its financial burden as well. It is this dual dynamic that has created the cost problem in mental health care. If we are to allocate resources to those most in need, we must fund patients rather than facilities and provide incentives to use appropriate, less expensive care.

The second anomaly in the mental-health system is found in the outpatient sector, where increasingly we are providing a level of coverage that treats the healthiest patients and excludes the sickest from any care at all. How did this come about? Managed-care companies and, more recently, other third-party payers have redefined traditional outpatient care to make it so brief that it is evidently inadequate for those in greatest need.

Twenty-session treatments for healthy adults going through difficult transitions in life such as divorce or death of a family member, can be justified and are good mental hygiene. But we cannot treat a learning-disabled child or even an abused child in twenty sessions of crisis intervention.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

First Steps toward Mental Health-Care Reform
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.