Managed Care and Mental Health Services: How We Got to Where We Are

Abstract

In September 1997, the NationalAlliance for the Mentally Ill issued a national report card asserting that managed care companies are falling short of their promise to deliver high-quality care to people with mental illnesses. This article traces how mental health care has evolvedfrom the overbuilding of psychiatric facilities in the mid and late 1980s to a situation in which millions of mentally ill Americans cannot receive adequate care. It traces events that led to the unprecedented boom in psychiatric care through the 1980s to the place where health care reform has evolved. The disparity between insur ance coverage of mental health care services and general medical care services is dis cussed, and the legislative outcome of recent mental health reform is described. Finally, implications for nursing and recommendations for action are considered. (J Am Psychiatr Nurses Assoc [1998]. 4, 153-161)