To the New York Times. Value Behavioral Health, a company formed by the merger of American Psych Management and Preferred Health Care, Ltd., will be, according to Mental Health Weekly (November 8, 1994), “the nation's largest managed mental health, substance abuse and EAP company. It will cover 12.5 million lives….”
The new company sent a Clinical Practice Profile to all mental health professionals providing services for the company. Providers were asked to indicate which of twelve treatment specialties they were trained to provide. Individual psychodynamic psychotherapy was not included on the list, let alone intensive psychotherapy or psychoanalysis. Apparently, the nation's largest managed mental health care company does not consider psychodynamic psychotherapy an appropriate mental health service.
Confirmation that this is indeed its view is provided by a New York Times report of April 12, 1994, that Value Behavioral Health uses a new Integra system to measure treatment by computer. The average number of therapy visits for mental health and substance abuse was reported at 3.5 per patient. This average clearly documents that psychotherapy is not provided. This covert decision to exclude psychotherapy from mental health services ignores the many scientific studies showing it to be effective, in that it produces significantly greater improvement than does a placebo. Further, a multicenter NIMH study of treatment of depression demonstrated (1) that psychotherapy plus medication is more effective than medication alone; and (2) that twenty psychotherapy sessions is inadequate for the treatment of depression. Were the nearly eleven million Americans who suffer from depression each year—at an annual cost estimated at $44 billion (Greenberg et al., Journal of Clinical Psychiatry, 1993)—to be treated by managed care companies, they would be doomed to inadequate treatment and subjected to a very high relapse rate.
Let those who support President Clinton's managed care approach to health services, including mental health services, pause and consider the view afforded us by Value Behavioral Health of the brave new world of managed care that awaits us all—unless vociferous objections are raised at every level of government.
If all are entitled to health care, if health care is a right, then it should not be controlled by profit-seeking companies whose interest lies in minimizing services in order to maximize profits. Woe betide those who put the fox in charge of the henhouse.
Joseph Schachter, M.D., Ph.D.
Pittsburgh