Privatization and Mental Health Care: A Fragile Balance

Privatization and Mental Health Care: A Fragile Balance

Privatization and Mental Health Care: A Fragile Balance

Privatization and Mental Health Care: A Fragile Balance

Synopsis

Effective and compassionate mental health policy in the U.S., or its absence, has long fueled the outrage of those who have understood the wretched conditions so often visited on the mentally ill. Dorwart and Epstein consider the evolution of the nation's approach to the issues relating to mental health care policy. They offer a highly informative historical review, setting the context and background for the analysis of economic, quality of care, and other critical issues relating to the formation of policy. They explore the movement toward institutionalization and later toward deinstitutionalization and from public care and public costs to increasing privatization. They urge that the mental health system be viewed in the context of two other systems--health care and social services.

Excerpt

All mental health professionals owe a debt of gratitude to Bob Dorwart and Sherrie Epstein for this splendid monograph; it pulls together in a succinct and masterful fashion what is known and not known about the effects of privatization on the delivery of mental health services and analyzes the current state of affairs in a sober and thoughtful fashion. Dorwart and Epstein make clear that the field is long on claims for or against one or another position and disappointingly short on data to validate those claims. The data Bob Dorwart and his colleagues have gathered in studies carried out in Massachusetts and in a major NIMH- supported national study is about the best information available. Reviewing the available literature, the message the authors leave with us is the urgent need for systematic research on the outcomes of system-wide policy changes before state or federal officials buy into schemes, which are sold on the ground they will improve access but may instead beggar public providers (Clark and Dorwart, 1992).

Discussion of health policy faces a serious built-in hazard. On the one hand, the problems policy proposals attempt to engage are of daunting complexity; on the other hand, the ground rules for public debate allow so little time and space for presentation and rebuttal that all participants resort to evocative slogans that imply all-encompassing panaceas. Yet, at best, proposals must be provisional, in need of modification on the basis of experience after the policy has passed the point of no return.

Professor Michael Shepherd (1989) has reminded us that the danger was recognized in a remarkably prescient article on community mental health . . .

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