Institutional Values of Managed Mental Health Care: Efficiency or Oppression?
Wilcoxon, S. Allen, Magnuson, Sandy, Norem, Ken, Journal of Multicultural Counseling and Development
The authors suggest that many managed mental health care (MMHC) practices have oppressive effects on members of cultural and ethnic minority groups. They examine the dissonance between institutional practices and cultural traditions that reflect insensitivity and forced conformity, particularly regarding time, pace, and intervention uniformity as applied to clients and commonly required in the MMHC industry.
Los autores sugieren que muchas practicas del cuidado administrado de la salud mental (MMHC, por sus siglas en ingles) tienen efectos opresivos sobre los miembros de grupos de minorias etnicas y culturales. Examinan tambien la disonancia entre practicas institucionales y tradiciones culturales que reflejan insensibilidad y una conformidad forzada, sobre todo en lo referente a tiempo, ritmo y uniformidad de intervencion tal y como se aplica a clientes y normalmente requeridos por la industria de MMHC.
Professional counseling has a long and sustained devotion to efforts concerning multicultural awareness and sensitivity. Whether through promoting curricular requirements in graduate study (e.g., the Council for Accreditation of Counseling and Related Educational Programs), creating an American Counseling Association (ACA) division devoted to multicultural concerns (i.e., the Association for Multicultural Counseling and Development), or establishing a sociopolitical presence in behalf of marginalized or oppressed groups, ACA and professional counselors in general have a clear and continued commitment to a multicultural perspective in education, supervision, research, and practice. These efforts, as noted, seem to have emerged from various sources during the past 40 years. Regardless of their origins, however, contemporary ethical counseling practices are grounded in appreciation of and respect for diversity.
Coincidental to the period of emerging emphasis on multicultural awareness and competencies in counseling practices (Roysircar, Arredondo, Fuertes, Ponterotto, & Toporek, 2003) has been the evolution of the managed mental health care (MMHC) industry. Efforts to control spiraling costs to insurance and health-related agencies during the past 25 years have led to a proliferation of rules, oversight, and restrictions affecting independent and agency practitioners seeking third-party reimbursement for their services to clients (Gerig, 2007). Legislative and business interests have come to dominate decisions in mental health care.
One outcome of this evolution in human services has been the emergence of health maintenance organizations (HMOs), whose mission is to promote cost-containment practices that limit the number of counseling sessions, restrict for services, and even specify treatment modalities (Polkinghorne, 2001). Such changes have led to limited options for tailored client care, often because of the necessity for reliance on standardized treatment protocols for specific diagnostic categories. For example, Chambliss (2000) noted that for specific diagnoses (e.g., chemical addiction), contemporary HMOs may require (a) specific treatment modalities (e.g., group counseling), (b) specific treatment settings (e.g., inpatient care), and (c) specific treatment periods (e.g., 28 days) that are all based on calculated cost-benefit ratios. Similar specifications about intervention protocols exist for other diagnoses (e.g., eating disorders and anxiety disorders). Although such protocols are based on outcomes from research findings, less standardized approaches are typically disqualified for reimbursement because they are cost prohibitive (Chambliss, 2000). Some HMO procedures have even led to the widespread practice of outright rejection of fee-reimbursement requests for specific diagnostic categories (e.g., Axis II diagnoses and V-Codes).
Evolution in MMHC practices and professional attention to counselors' multicultural competencies are not unrelated historical trends. …