Mental Health and Social Policy: The Emergence of Managed Care

by Mechanic, David

• ISBN13: 9780205269938
• ISBN10: 0205269931
• Edition: 4th
• Format: Paperback
• Copyright: 1999-01-01
• Publisher: Allyn & Bacon

Summary

Just a few years ago there was much optimism that the American health care system would be reformed and that we would have a system of universal insurance entitlement with few people uninsured. The realization that full mental health benefits would only be financially acceptable within a managed care framework suggests the importance of managed care as an instrument for achieving broader coverage at an acceptable cost. Yet, it remains to be seen to what extent the marketplace will direct the future development of managed care and what role professional agencies, government, and consumer organizations will have in making managed care organizations accountable to the public. This book takes a multidisciplinary approach to mental health and social policy. It covers mental health issues such as definitions of mental disorders, the epidemiology of mental illness, case management, community treatment, mental health research, and questions of policy. It also includes the definitions of disability and the links to federal programs and housing and employment services that will be of special interest to social workers. Mental health care providers, social workers, and therapists.

Table of Contents

Preface	xi
Mental Health and the Mental Health Professions	1	(18)
Symptoms, Diseases, and Reaction Patterns	3	(1)
Disease, Personality Disturbance, or Problem in Living	4	(1)
Social Adjustment	4	(1)
Patterns of Mental Health Utilization	5	(2)
The Mental Health Professions	7	(2)
Mental Health Personnel and Work Patterns	9	(4)
Trends in Mental Health Care	13	(3)
Changing Inpatient Care	16	(3)
What Are Mental Health and Mental Illness?	19	(28)
Psychiatric Diagnosis Guidelines	19	(3)
Varieties of Mental Illness	22	(1)
Schizophrenia: An Example in Psychiatric Conceptualization	23	(5)
Varying Conceptions of Mental Illness	28	(5)
Developmental Models	33	(2)
Changing Conceptions of Mental Illness	35	(2)
Social Conceptions of Mental Illness	37	(3)
Views of Mental Illness in Relation to Social Policy	40	(3)
The Patient and the Society: An Insoluble Dilemma	43	(1)
Social Problem or Mental Illness?	44	(3)
Psychological Disorder and the Flow of Patients into Treatment: The Study of Psychiatric Epidemiology	47	(18)
Identifying Psychological Problems in Community Populations	48	(3)
Estimates of Prevalence of Disorder in Community Populations	51	(1)
The Epidemiological Catchment Area Program and the National Comorbidity Survey	52	(3)
Psychological Disorder and Utilization of Care	55	(4)
Social Factors Associated with Psychiatric Conditions in the Community	59	(4)
The Epidemiology of Antisocial Behavior and Behavior Disorders	63	(2)
Conceptions of the Causes of and Means of Controlling Mental Illness	65	(22)
The Impact of Environment on Mental Illness	65	(1)
The Question of Inheritance and Environment	66	(3)
A Note on Psychiatric Drugs	69	(3)
The Psychosocial-Development Perspective	72	(5)
The Learning Perspective: Behavior Therapy	77	(2)
The Social-Stress Perspective	79	(4)
The Labeling Perspective	83	(2)
Collective Mobilization	85	(2)
The Development of Mental Health Policy in the United States	87	(24)
The Early History of Worcester State Hospital	90	(1)
More Recent Developments in Mental Health Policy	91	(2)
Post-World War II Developments in Mental Health Policy	93	(1)
Postwar Psychiatry	93	(9)
The Organization of State Mental Hospitals	102	(3)
Programs of Community Care	105	(1)
The Composition of the Seriously Mentally Ill Population	106	(2)
Homelessness and Mental Illness	108	(3)
The Recognition of Mental Disorders	111	(16)
Mental Illness, Illness Behavior, and Entry into Psychiatric Care	113	(6)
Community Definitions of Mental Illness	119	(5)
The Course of Schizophrenia	124	(3)
The Financing and Delivery of Mental Health Services	127	(24)
Mental Health Coverage and Expenditures	128	(2)
The Pattern of Inpatient Services	130	(1)
Utilization of Services and Financing Patterns	131	(1)
The Economics of Mental Health Care	132	(2)
Psychiatric Care under Prepayment Plans	134	(3)
The Structure of Insurance and Needed Mental Health Benefits	137	(6)
An Epidemiological Approach to Psychiatric Need	143	(1)
The Role of Primary Medical Care	144	(3)
The Management of Psychological Distress	147	(4)
Managed Mental Health Care	151	(16)
Basic Mechanisms of Managed Care	152	(2)
Types of Managed Care Organizations	154	(2)
Managed Care for Persons with Mental Illness	156	(3)
Opportunities and Special Problems in Managed Mental Health Care	159	(1)
Performance of Managed Care	160	(4)
Some Unresolved Issues in Managed Care	164	(3)
Central Perspectives in Formulating Mental Health Policies	167	(35)
Concepts of Severe and Persistent Mental Illness	167	(2)
Criteria for Evaluation	169	(7)
The Processes of Deinstitutionalization	176	(3)
Environmental Factors Promoting Effective Performance	179	(6)
Implications of Community Institutional Placement	185	(1)
Models for Community Care	186	(7)
Points of Leverage	193	(5)
Modifying State Mental Health Systems	193	(1)
Medicaid Reform	194	(2)
Improving Disability Determination	196	(2)
The Case-Management Approach	198	(1)
Organizational Barriers	199	(3)
The Absence of a Clear Focus of Responsibility and Authority	200	(2)
Innovations in Mental Health Services	202	(14)
Maintenance of Patients with Persistent Disorders	205	(3)
A Further Note on Employment	208	(2)
Problems in the Diffusion of Mental Health Innovations	210	(1)
Innovations in Housing	211	(2)
Changing Roles of the Mental Health Professions	213	(1)
Future Trends in Innovative Mental Health Services	214	(2)
The Social Context of Mental Health Practice: Foundations of Trust	216	(14)
Social Influences on Psychiatric Judgment	220	(1)
Personal and Social Biographies	220	(2)
The Sociocultural Context	222	(4)
Constraints of Practice Organization and Settings	226	(1)
Competition in the Allocation of Care	227	(1)
A Note on the Care of Chronically Impaired Patients	228	(2)
Mental Illness, the Community, and the Law	230	(20)
Involuntary Hospitalization	231	(6)
Outpatient Commitment	237	(1)
A Note on Dangerousness and the Relationship between Mental Illness and Violence	238	(4)
The Right to Treatment	242	(3)
Right to Refuse Treatment	245	(2)
The Social Context of Legal Reform in Mental Health	247	(3)
References	250	(23)
Name Index	273	(6)
Subject Index	279