Over the past twenty-five years, psychiatric services have shifted from hospital to community. Managed care reinforces this trend. Mental illness is better understood and less stigmatized, and services are more commonly used. But many in need do not receive care consistent with evidence-based standards, or at all. Challenges are greatest for people with serious and persistent mental illnesses who depend on generic health and welfare programs and integrated services. Evidence-based rehabilitative care is often unavailable. Failures in community care lead to arrest; jail diversion and treatment are required. Despite progress, implementing an effective, patient-centered care system remains a formidable challenge.
"45). See also Birenbaum (1997); Dranove (2000); Mechanic (2007); Morreim (1995a), (1995b); Scott et al. (2000). 2. I use the shorthand terms " managed care model " and " managed care approach " in this paper to characterize the overarching ideological and practical contours of managed mental health care in the United States, specifically, the primacy placed on cost effectiveness, efficiency, and predictability of outcomes. "
[Show abstract][Hide abstract] ABSTRACT: This paper examines the moral work of a controversial psychiatric diagnosis--Borderline Personality Disorder--in an American eating disorder treatment center in the era of managed mental health care. Based on fieldwork at this clinic spanning more than 6 years, I consider how clinicians invoke aspects of Borderline Personality Disorder in everyday conversation, in a practice I call "borderline talk." I argue that borderline talk emerges in response to being caught between contradictory models of the subject entailed in managed care and psychodynamic discourses. Specifically, borderline talk enables clinicians to endorse a formulation of the subject that, although considered pathological, provides them with a clear path of ethical action in otherwise ethically ambiguous situations. These kinds of everyday ethical negotiations percolate throughout the American health care system and are key mechanisms through which notions of economic expediency become entangled with concepts of the healthy subject. As clinicians struggle out a course of action between competing ethical imperatives, they also struggle out the workability--and failures--of various articulations of the subject within contemporary American cultural ideologies of health and pathology.
Current Anthropology 06/2009; 50(3):281-302. DOI:10.1086/598782 · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article presents findings of a quantitative study that illuminates the 'sense of competence' of American social workers practicing in a new financial reimbursement and treatment health care system called 'managed care'. Questionnaires completed by 140 social workers provided data about the relationships between self-perceived competence and outcome variables including burnout and role stress. Findings: A central finding was that social workers who felt competent in their abilities to practice in a managed care environment also reported lower levels of role stress and burnout. Other findings included that those working with clients with severe and persistent mental illness reported lower levels of sense of competence and higher levels of role stress and burnout symptoms. Applications: Potential implications for research, education, and practice with the focus of increasing workers' knowledge and skills when providing services in a managed care environment are addressed. Future research is recommended to include more diverse samples that provide a more comprehensive picture of the population of social workers in the USA.
Journal of Social Work 06/2009; 9(3):269-283. DOI:10.1177/1468017309334902 · 1.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the relationship between social workers' experiences when interfacing with managed care organizations and burnout. A total of 591 social workers completed questionnaires that included several measures: Self-perceived competence in the context of managed care, professional involvement with clients with severe mental illness, and burnout. Results showed that self-perceived competence in the context of managed care had statistically significant correlations with burnout dimensions. The author discusses the role of social work schools in preparing students for the realistic aspects of mental health work, and recommends a partnership between managed care organizations and professionals for best care giving.
Community Mental Health Journal 11/2009; 46(6):591-600. DOI:10.1007/s10597-009-9269-5 · 1.03 Impact Factor
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