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Managing Care, Not Dollars: The Continuum of Mental Health Services / Edition 1

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Overview

By 1994 the total cost of health care in the United States approached $900 billion annually. In reaction to this explosive growth, the managed care industry, acting as the agent and administrator for government and health care payers, has taken an increasingly aggressive stance on controlling costs with a view toward hospitalization as the last option for mental health treatment. This new emphasis on cost containment demands effective and less costly alternatives to hospitalization.

Although most clinicians have grudgingly accepted the inevitability of both managed care and cost controls, the question remains: How can we develop a coherent mental health care system that controls costs while working effectively for both patients and clinicians? In Managing Care, Not Dollars, leading clinical experts argue that in order to survive, psychiatric institutions must offer a full range of services to large numbers of patients. Rather than concentrating on budget issues, clinicians and hospital administrators should use advances in treatment and technology to develop a coherent continuum of mental health care capable of delivering a wide variety of effective treatment options and alternatives to hospitalization.

This guide to the creation and use of the emerging continuum of care provides an in-depth examination of the individual components of seven state-of-the-art treatment programs including suitable patients, treatment goals, staffing, physical plant, and special adaptations for children and the elderly. It also offers decision-making tools for managers to use to adapt their existing programs to survive in this new era and reviews the various public policy issues arising out of the health care transformation. By reading this book, clinicians, policymakers, and administrators can begin to grapple with the problem of learning to do more with less.

American Psychiatric Publishing

The book contains black-and-white illustrations.

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Editorial Reviews

Choice
Current and future mental health providers will find much value in this carefully edited book.... A must for mental health professionals, general readers, graduate students, and faculty.
Choice

Current and future mental health providers will find much value in this carefully edited book.... A must for mental health professionals, general readers, graduate students, and faculty.

Psychiatric Times
This edited work is timely and has as its aim assisting clinicians, policy makers and administrators to provide effective care in a managed care world.
Doody's Review Service
Reviewer: John K. Larson, MD (Rush University Medical Center)
Description: This is a compilation of descriptive articles from authors representing over 20 mental health care systems and agencies. The articles are primarily of a "how we did it" nature describing the design and implementation of a wide variety of novel treatment programs distributed all along the continuum of intensity and restrictiveness, including traditional acute inpatient and partial hospital services, office-based care, community programs, crisis intervention, residential treatment, and home-based services. Populations served include children, adolescents, adults, and the elderly, suffering from acute episodes of mental illness as well as the chronically and pervasively mentally ill.
Purpose: The editors and authors are clearly advocating for a flexible, innovative continuum of mental health services in response to increasing demands for managed, cost-effective care rather than hand-wringing and focusing solely on budgetary issues. The book is offered as an example of the results of that innovation.
Audience: The book is directed primarily at medical directors, policymakers, and mental healthcare system administrators. However, this should not discourage the practicing clinician from reading these descriptions of innovative programming to stimulate his/her own creative thinking about the future of psychiatric healthcare.
Features: Most articles are written in a clear, pragmatic style with varying degrees of detail about the design, structure, and actual delivery of services in the systems described. There are few tables and no illustrations. Each article concludes with a brief bibliography.
Assessment: The book successfully illustrates how mental health care can be delivered by innovative, creative clinicians in response to the current demands for accountability and cost containment. Whether these approaches will ultimately represent value for our patients and their families remains to be seen. In the meantime it is refreshing to share the experiences of clinicians on the front lines who have responded to our current dilemma with hope and vision.
John K. Larson
This is a compilation of descriptive articles from authors representing over 20 mental health care systems and agencies. The articles are primarily of a "how we did it" nature describing the design and implementation of a wide variety of novel treatment programs distributed all along the continuum of intensity and restrictiveness, including traditional acute inpatient and partial hospital services, office-based care, community programs, crisis intervention, residential treatment, and home-based services. Populations served include children, adolescents, adults, and the elderly, suffering from acute episodes of mental illness as well as the chronically and pervasively mentally ill. The editors and authors are clearly advocating for a flexible, innovative continuum of mental health services in response to increasing demands for managed, cost-effective care rather than hand-wringing and focusing solely on budgetary issues. The book is offered as an example of the results of that innovation. The book is directed primarily at medical directors, policymakers, and mental healthcare system administrators. However, this should not discourage the practicing clinician from reading these descriptions of innovative programming to stimulate his/her own creative thinking about the future of psychiatric healthcare. Most articles are written in a clear, pragmatic style with varying degrees of detail about the design, structure, and actual delivery of services in the systems described. There are few tables and no illustrations. Each article concludes with a brief bibliography. The book successfully illustrates how mental health care can be delivered by innovative, creative clinicians in response tothe current demands for accountability and cost containment. Whether these approaches will ultimately represent value for our patients and their families remains to be seen. In the meantime it is refreshing to share the experiences of clinicians on the front lines who have responded to our current dilemma with hope and vision.
Contemporary Psychology
This volume is consistently well-written and substantive without bogging down in the complex area of mental health service delivery. It is an exciting and thoughtful presentation of the continuing evolution in the provision and organization of managed mental health services.
American Journal of Psychiatry
Given the data offered, the present volume will no doubt become required reading for public policy programs and mental health administration courses as well as for programs in mental health, ethics, and the law that are ready to proceed to the requisite next level of analysis.
Journal of Clinical Psychiatry
Clearly and cogently presented, Managing Managed Care, Not Dollars is a 'must read' for consumers, clinicians, and managers of mental health services

3 Stars from Doody
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Product Details

  • ISBN-13: 9780880488556
  • Publisher: American Psychiatric Publishing, Incorporated
  • Publication date: 12/28/1996
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 400
  • Product dimensions: 6.00 (w) x 9.00 (h) x 1.30 (d)

Meet the Author

Robert K. Schreter, M.D., is Medical Director of Psych Services, Inc., Baltimore, Maryland, and Assistant Professor of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland.

Steven S. Sharfstein, M.D., M.P.A., is Medical Director and C.E.O. of The Sheppard and Enoch Pratt Health System, Baltimore, Maryland, and Clinical Professor of Psychiatry, University of Maryland Medical School, Baltimore, Maryland.

Carol A. Schreter, M.S.W., Ph.D., is a freelance writer on health and aging based in Baltimore, Maryland.

American Psychiatric Publishing

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Table of Contents

Managing care, not dollars. Components of the Continuum. Office-based services. Home-based services. Emergency crisis services. Community residential care for adults. Partial hospital care. Hospital-based alcohol and drug treatment. Acute inpatient treatment. Using the Continuum for Children, Adolescents, and the Elderly. Foster care. Residential treatment centers for youth. Alternative treatment services for children and adolescents. School-based mental health programs. The elderly patient. Planning and Administering the Continuum. The economic case for the continuum of care. Case management and clinical decision making. Computer decision-support as a clinician's tool. Outcomes management. Restructuring for survival: the Sheppard Pratt transformation. Training residents in the era of managed care. Public Policy Issues and the Continuum. Role of the public sector. Beyond the continuum: community, family, and consumer services. Conclusion. Learning to manage care. Index.

American Psychiatric Publishing

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