The delivery system for mental health in the US has shifted from state financed institutions, where patients were cared for in state hospitals and psychiatric asylums to more federally based programs that focus on treatment in the community (Cunningham et al., 2006). The first two developing changes in the mental health system arose in the 1990’s. One of these changes was the physical and therapeutic treatments of the mentally ill. As president Bush notoriously called this the decade of the brain, research in the neurosciences led to the rise of new marketable drugs from pharmacies, as well as new cognitive therapies which had replaced the past psychodynamic approach (Mechanic, 2007). Now primary care physicians were prescribing drugs for depression and anxiety, which was not
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The other major change in the 90’s was the implementation of managed care. Private and public sectors were now somewhat integrated with some sort of large private organization which used its management to reduce costs by shortening inpatient stay and utilizing psychiatrists (Mechanic, 2007). According to David Mechanic (2007), “managed care has made specialty mental health services more accessible and reduced the intensity of service and cost without obvious reduction in quality” (p.1549). This seems to be a controversial statement as we look further into the fragmented system of mental health.
As the mental health system evolved into a community-based program, it gradually integrated into the mainstream health system of the US. Now Medicaid and other mainstream programs controlled the mental health dollars, and were in charge of eligibility for who could be covered. With tight state budgets and increasing Medicaid costs, many states tried to contain costs through reduction of eligibility requirements, lower Medicaid reimbursements as well as increasing cost sharing and restrictions
The other major change in the 90’s was the implementation of managed care. Private and public sectors were now somewhat integrated with some sort of large private organization which used its management to reduce costs by shortening inpatient stay and utilizing psychiatrists (Mechanic, 2007). According to David Mechanic (2007), “managed care has made specialty mental health services more accessible and reduced the intensity of service and cost without obvious reduction in quality” (p.1549). This seems to be a controversial statement as we look further into the fragmented system of mental health.
As the mental health system evolved into a community-based program, it gradually integrated into the mainstream health system of the US. Now Medicaid and other mainstream programs controlled the mental health dollars, and were in charge of eligibility for who could be covered. With tight state budgets and increasing Medicaid costs, many states tried to contain costs through reduction of eligibility requirements, lower Medicaid reimbursements as well as increasing cost sharing and restrictions