ABSTRACT
Cataclysmic changes taking place in the name of “managed care” threaten the foundations of public sector mental health care. Community psychiatrists worry that managed care will mean that their severely ill patients will receive inadequate treatments resulting in tragic outcomes. They fear that the arbitrary decisions of utilization managers will supersede clinical judgments. They want to know how managed care, with its emphasis on cost-containment, can be applied to the critically scarce resources of the public sector. Psychiatrists who work in public-sector settings doubt that adults with severe and persistent mental illness (SPMI), children with severe emotional disturbances (SED), and patients with disabling substance abuse disorders can be treated effectively in systems using the managed care techniques of the private sector.
