The Human Toll: Managed Care's Restriction of Access to Mental Health Services

Since the 1980s, the cost control measures instituted by managed care practices for health care have curtailed access to all medical services. This cost control trend has resulted in an increasing burden, especially for the vulnerable users of mental health services.

The protocols practiced by managed care severely restrict both the frequency and length of mental health treatment. Generally, managed care limits treatment from three to 20 visits, effectively excluding coverage for severe or chronic mental illness, which requires long-term care (Welch, 1994). In contrast, there are numerous studies documenting the needs of certain patient groups for extended psychotherapy. The research suggests need for 1-2¹/₂ years of psychotherapy for patients with borderline personality disorder and 2¹/₂ or more years for those with dissociative disorder and the need for the ongoing availability of psychotherapy for patients with depression (Klerman et al., 1974; Kluft, 1988; Putman, 1989; Ross, 1989; Frank et al., 1991; Stevenson and Meares, 1992; Fonagy and Target, 1992; Lowenstein and Putman, 1993; Lanktree and Briere, 1993; Barach, 1994). The vignettes below detail the consequences of limitations by managed care practices of both inpatient and outpatient mental health treatment.