ABSTRACT
Once again behavioral healthcare is about to experience dramatic changes that will rival those of the mid-1980s. The behavioral healthcare professions failed then to recognize the impending industrialization of healthcare, and thus found themselves left out of the subsequent decision-making process. Although the next leap forward will be evolutionary rather than revolutionary as was the period we are experiencing, the mental healthcare professions will have the first real opportunity in several years to participate in the future of behavioral healthcare. In the previous decade, the professional guilds ignored the trend toward industrialization, and remained oblivious to the disturbing fact that insurers were rapidly dropping mental healthcare as a benefit. Within a short time, the hard-fought psychotherapy benefits of health insurance would have disappeared if the early managed behavioral care companies (American Biodyne, American Psych Management, MCC, and Preferred Health) had not demonstrated to the industry that they could roll back costs and cap them for 3 years, all the while expanding the mental healthcare benefit. The immediate losers were the psychiatric hospitals and the solo practitioners of long-term psychotherapy, for it was by reducing these overly utilized services that stability was quickly acquired. The beneficiaries were those who pay the costs and the patients who now had a new continuum of care. Managed behavioral care has resulted in an expansion of services as well as a substitution of services, with increases in psychiatric rehabilitation, day treatment, consumer-run peer support, residential treatment, and crisis programs in lieu of psychiatric hospitalization and private practice psychotherapy, both of which declined and have never recovered (Ross, 1998; Cummings, 1999).
