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On Feb. 28, ISTSS Executive Director Greg Schultz and I represented ISTSS at an important meeting in Washington, D.C., at the invitation of the American Psychiatric Association. The APA invited 23 organizations to discuss the impact of managed care on their particular patient populations. Organizations included the National Alliance for the Mentally Ill, the American Academy of Child and Adolescent Psychiatry, American Society of Addiction Medicine, Child Welfare League of America, Obsessive Compulsive Foundation, National Association of Social Workers and the American Academy of Hispanic Psychiatry.

Harold Eist, MD, president of the APA, has been an outspoken critic of managed care policies that have severely jeopardized the treatment of the mentally ill. After years of trying to improve the situation through negotiations with managed care companies, Eist and his colleagues concede that the situation continues to degenerate.

Eist was instrumental in developing a broad-based coalition of mental health groups, the Mental Health Professionals Coalition, a constructive effort to overcome the interdisciplinary warfare that has plagued the mental health field. This group represents over half a million mental health professionals from all disciplines. On Feb. 20, the coalition held a press conference to introduce a patients' Bill of Rights.

This Bill of Rights asserts that patients have the right to know the full extent of their health benefits, to know the credentials of treating professionals, to know how these professionals are paid and to appeal unfair practices. The document asserts that patients have the right to confidentiality, to choose who they want to treat them, to use the entire scope of their benefits, to fair and appropriate medical review of their care and to hold both the professional, health-care organizations and insurer accountable for harm.

It also insists on the right to receive mental health benefits on the same basis as other illnesses and the right not to be denied other benefits, like life insurance, just because they have sought mental health treatment. The response to this document from one representative of the managed care industry was that the rights are "unrealistic." Nonetheless, this document is being distributed to every member of Congress, major health insurance and managed care organizations, health professional organizations, advocacy groups and the public at large.

At the meeting Jack Schoenholtz, MD, presented information on the economics of health care, detailing the benefits insurance companies have accrued from the creation of the present managed care environment. He believes that a grass roots movement is developing to reverse the current excesses and abuses, as more members of the public suffer from detrimental and sometimes lethal practices.

To assist in this reform process, Eist announced the formation of a nonprofit organization dedicated to health care based on the privacy of a doctor­patient relationship controlled only by the needs of the patient rather than by corporate financial interests.

This organization, The Legal Center for Patient Protection, seeks to be a clearinghouse, offering information and guidance for patients who have grievances against managed care. The Center will provide professionals and consumers with legal consultation about the potential for access to federal and state courts and regulatory agencies when other attempts at redress fail. When litigation is appropriate, local legal counsel may collaborate with the Center, which can bring together specialists with collective clinical and forensic experience. Social change is usually preceded by successful legal precedent, but until now, relatively few attorneys have understood the intricacies involved in federal and state regulation of the insurance industry. The Center will provide the guidance that trial attorneys need.

If you, your patients or their families want to lodge a grievance and explore the possibility of litigation against a managed care practice, you should contact the Center, tel. (202)429-6530; fax, (202)332-8710. Staff are particularly interested in speaking to patients or their family members about their experiences.

ISTSS must consider its position vis-à-vis managed care and what steps the organization should take to help guarantee trauma patients access to the level of care they need. The ISTSS Executive Committee is considering the following proposals:

  • Construct a survey of members to get more detailed information about how managed care has been impacting specifically on the treatment of trauma survivors.
  • Take whatever steps are necessary to position the ISTSS as one of the players in this developing coalition.
  • Offer our mailing list to the Center for the solicitation of funds
  • Promote the development of treatment guidelines. Various organizations are doing this in order to set a standard that managed care must abide by if they are to avoid being below the standard of care.
  • Distribute information about the Mental Health Bill of Rights Project and the Legal Center for Patient Protection to ISTSS members.