Managed Care Puts Millions With Severe Mental Illness at Risk, Landmark Study Reveals

Posted on September 17, 1997

Washington, D.C. - Managed care fails to make the grade in providing adequate care for persons with mental illness in publicly funded programs, according to a national report card released today by the National Alliance for the Mentally Ill (NAMI).

Stand and Deliver: Action Call to a Failing Industry reports that managed care is failing to bring the best clinical practices to people with mental illness and falling short on its promise to reform the public mental health system into an accountable, comprehensive community-based system of care.

"Our report card clearly shows that cost-cutting is being done at the expense of the sickest individuals who are most at risk for disaster," said NAMI Executive Director Laurie Flynn at the National Press Club today. "Managed care in the public sector will have tragic results for people with severe mental illnesses if the industry continues along its current path."

The NAMI report card profiles nine major public-sector managed behavioral health care companies and grades each against critical components of care – NAMI’s measures of success – such as access to the latest drugs and suicide response. NAMI fails the industry overall.

Particularly alarming, notes the NAMI report card, is the degree to which managed care companies ignore core life-saving treatment requirements:

• Less than half of company respondents define suicide attempt as a medical emergency or describe policies that ensure immediate care.
• Companies use scientifically out-of-date treatment guidelines that often do not mention the newest medications that are more effective in many cases and have fewer side effects than older drugs.
• Companies strictly limit hospital care, denying inpatient treatment for patients who are disruptive and who do not comply with treatment – common characteristics of serious mental illness.

The NAMI report card also criticizes the managed care industry for neglecting critical community support services, such as housing, rehabilitation and community treatment programs that effectively keep people out of the hospital and on the road to maximal recovery. Further, accountability through meaningful public involvement and outcomes measurement is woefully inadequate, the report card charges.

"Managed care must offer the treatments and supports necessary for people with disabling brain disorders to live in the community," said NAMI President Annie Saylor, Ph.D. "Not only do our members’ lives depend on it, but it makes good business sense to offer a total system of care that helps people become and stay as well as possible."

In addition to urging managed behavioral health care organizations to revise and update existing policies and programs, NAMI is calling on federal and state policy-makers to address core issues to head off a threatening crisis.

The results of the report card are based on an analysis of written survey responses from the following public-sector managed behavioral care companies: CMG Health, Green Spring Health Services, Human Affairs International, MCC Behavioral Care, Merit Behavioral Care, OPTIONS Health Care, Inc., PacifiCare Behavioral Health, Inc., United Behavioral Health, and Value Behavioral Health.

With more than 168,000 members nationwide, NAMI is the nation’s leading grassroots organization solely dedicated to improving the lives of persons with severe mental illnesses, including schizophrenia, bipolar disorder (manic-depressive illness), major depression, and anxiety disorders. NAMI’s efforts focus on support to persons with serious brain disorders and to their families; advocacy for non-discriminatory and equitable federal and state policies; research into the causes, symptoms and treatments for brain disorders; and education to eliminate the pervasive stigma toward severe mental illness. NAMI has more than 1,140 state and local affiliates in all 50 states, the District of Columbia, Puerto Rico, and Canada.