McDonald's Style: Mangled Care and Managed Costs
"Managed care" is the phrase given to indicate increased involvement by insurance companies to supposedly "manage" your health care. This management can take numerous forms: selecting which health care professional you can see, determining treatment options, defining a list of approved medications, requiring your physician or other professional to provide ongoing treatment updates, etc. In essence, your care is no longer between you and your doctor. "Managed care" is actually a misnomer. It is almost as contradictory as giving a bomb a name like "Peacemaker" (for those that recall this from the Reagan era). It would be accurate to call it "Managed Cost." The emphasis of such efforts is on costs - not care.
The reasons that Managed Costs came into existence are related to escalating costs to individuals and employers to provide medical services and coverage. This was largely not true, however, for mental health services with the exception of inpatient psychiatric programs. The one area of widespread escalating costs for mental health was inpatient care. Regular, outpatient mental health care has not ever increased substantially compared to the other areas of health care. Yet, it is now managed also and such management means less care available to individuals.
The results of managed costs on regular mental health care has been detrimental. The special, private, therapeutic relationship between therapist and client has been intruded upon. Your "privacy" is not as private. Instead of your therapist being the sole recipient of your personal information (shared in a private, confidential setting), some unknown "care manager" reads questions off a computer screen and types in responses. Despite the therapist's efforts to limit information as much as is possible, there is nonetheless an intrusive element to "managed costs."
In addition, the focus is on "short-term, problem-focused resolution." Managed costs companies make the argument that research supports such an approach. Well sure! If you conduct research to see if individuals who are depressed will benefit from cognitive-behavioral treatment of depression in an 8-week program, sure - you will find that they will benefit. Is that enough? Do we want your relationship with your doctor (therapist) to become like McDonalds where therapy is turned into duplicate distributions of services.
The "McDonalds" model of health care is too simplistic. The McDonalds approach of managed costs is not how it works in the real world. In the McDonalds world of managed costs, if your are "depressed" you order a cognitive-behavioral therapist from the menu, learn to recognize cognitive distortions, learn to dispute those cognitions, "restructure" those cognitions and then go on your merry way after your allotted 6 sessions. McTherapy, you might say. Life is too complicated to be squeezed into discrete, all-encompassing categories like "depression" or "cognitive-behavioral restructuring." Problems with life are about thoughts, feelings, beliefs, values, spirituality, relationships, physiology, biochemistry, etc. People want a doctor who is a real person, someone who will make individualized decisions for the client. Therapy is a live, dynamic process of genuine interaction. Knowledge and technologies are necessary to enhance the usefulness of therapy but it should not be cook-book, menu style approach that resembles fast-food. McTherapy compares in quality to a fast-food burger. Expect more for yourself.