With a Brief History of The National Coalition

by William MacGillivray, PhD

March 2001

The Coalition has been fighting to preserve choice, access and quality of mental health services for almost ten years. In the beginning, the work of the Coalition was primarily directed to mental health professionals providing information, and moral support as managed care began to make destructive inroads into mental health care. It is not surprising that many of the early supporters of the Coalition were private practitioners of intensive psychotherapy. We served as a kind of canary in the mineshaft testing the noxious fumes that were soon to vaporize all mental health services. Those early years were characterized by panic and manic hope that if only mental health professionals would stand together, managed care could be combated and toppled.

The debacle of the Clinton health plan, seemingly snatching defeat from the one issue that Clinton rode to victory was the first of many “come to Jesus” calls for the Coalition. Our erstwhile allies at the federal level abandoned choice, abandoned quality of care, and abandoned access in a cumbersome scheme that would have replaced the coercions of the marketplace with a government/corporate alliance that would do the same, and might put you in jail to boot. The defeat of the plan kept in place the worst excesses of managed care and an ongoing federal “hands off” policy toward monopolistic practices of managed care that made its next moves against the public sector itself. (I know I am being simplistic, but since when did the government have to act to give you the right to sue anybody. This is America, by God, the most litigious society on earth, yet one vile part of the economy gets a free ride. I don’t get it.)

The next years saw the Coalition, and the many smaller incarnations of the Coalition that sprung up around the country, begin to take up the arduous but seemingly workable quest of preserving psychotherapy through state legislative action. If the federals were not going to act, we could unite at the state level to effect change. In my own case, the East Tennessee Coalition came together with considerable support from the private practice community and a belief that through public education and legislative fiat, managed care could be rolled back and exposed for the sham it was. We had a lot to learn. Still the early years were exciting as embattled therapists across the country sought out like-minded fellows - a kind of “emperor’s new clothes” social movement - experiencing excitement and relief that we were not alone. More than that, the Coalition afforded us a voice to speak out about what was happening to our profession and our patients, especially during a time when our colleagues and professional organizations were counseling acquiescence and accommodation.

Well, the next few years saw some victories and a reawakening of some of our professional organizations. At the same time, the continually frustrating tactics of corporate health care undermined our few legislative victories and we saw the gradual encroachment of mental health managed care into the public health arena. There was small comfort in seeing our dire predictions come true as managed care intruded into the public sector and shredded that already limited safety net afforded by our state hospitals and mental health centers. Managed care was an accomplished Pied Piper who shamed one part of the mental health system as greedy providers and beguiled those who had felt marginalized under the “outmoded” system to entertain their own greedy visions of mental health care for the ‘truly needy.” Ivan Miller, for example, from his perspective as a mental health center psychotherapist, saw managed care as potentially redistributing mental health care dollars to comprehensive systems of care where patient needs could be addressed without having to place patients in ‘lock-step” treatments based upon indemnity reimbursement strategies.  He was quickly disillusioned and this is what propelled him to the forefront of clinicians battling managed care deceptions.

The evolution of the Coalition mirrored how many of us have seen the struggle. The major ambition of Rescue Health Care Day was the culmination of years of planning and grassroots coordination with organizations around the country to take back health care from corporate interests. Once again, the success of the Coalition in building disparate alliances and struggling with our own internal doubts about direction to keep a united front is an important testimony to our members, our board members, and in particular, our founder, Karen Shore.

Through eight fractious years Karen stood at the helm of our organization and tirelessly devoted herself to keeping a space open where psychotherapists and other mental health professionals and supporters could imagine a better, fairer and more open and just system of mental health care. As she completes her ninth year, she set before the board the question of how to move beyond the founders’ energy and vision and forge new directions for the Coalition.

The Coalition has been constantly reinventing itself fueled by the passion, the energy, and quite frankly at times, the anger of professionals who saw their livelihood threatened and more importantly, their value and competence demeaned and denigrated, all in the name of corporate profits. For those in the heat of the struggle, it is no surprise that the fire has singed us as well. The injuries and losses, particular and general, remain a profound legacy as the Coalition prepares to fight new battles and seek new allies and alliances.

The current goals of the Coalition are not all that new. Some of them have been present from the beginning. The difference is that we are now in a better position to fight for and achieve these goals than ever before. The recurring theme at our board meetings over the last year has been taking the battle for quality mental health care to the legislatures and Congress, to public policy debates, and most importantly, to the public at large.

We are focusing our agenda on preserving choice, access and quality of mental health care and from these core values on leveraging the national debate back toward these important concerns. Although we still identify managed care as the Prime Mover in the destruction of mental health care, it is time to focus on the broader and more positive message that quality mental health care is possible, desirable, and yes, even affordable. Managed care did not succeed by making people love its approach, although the lie that it would save money was seductive to some. It succeeded and will continue to succeed by spreading the more dangerous lies that quality mental health care is unnecessary, ineffective or trivial in its results, and only serves the interests of putatively greedy professionals.

Here are the fundamentals of the Coalition agenda: taking the battle “to the mat” by combating false information and providing accurate information about quality mental health care. To do this we will need to reach out from our constituency base, the hard-pressed professionals that have supported the Coalition since its inception, to the wider public arena. To accomplish this, we will establish the Foundation of the National Coalition of Mental Health Professionals and Consumers, a non-profit educational and advocacy arm of the Coalition. This will help us raise the considerable sums we will need to battle corporate interests on their own turf and provide accurate information to the general public. We have also formed a committee charged with hiring an executive director who will take charge of our fund-raising efforts and will allow our president and other board members to free up time and energy for several new campaigns, some of which will be evident as you read this newsletter. Many of you have already been asked to not only renew your membership but also contribute additional sums to move the Coalition beyond day-to-day concerns and to enable us to use this seed money to grow into our new missions.

The agenda for the Coalition is to focus on advocacy for mental health care. We will continue to nurture our contacts with healthcare grassroots organizations around the country that was initiated with Rescue Health Care Day. Board members Dave Byrom and Pat Dowds will be spearheading this effort through involvement with groups such as Y2K and other universal health care advocacy groups. Our position with these groups will be what it has been all along: to keep quality mental health care “on the table” regardless of which group is advocating what solution to the problem of health care delivery. The Coalition does not take any particular stand of health care delivery except to advocate for our patients and professionals who provide mental health care.

There are two new campaigns beginning this year. The first is “Inform America,” to address what real mental health care is and advocate for this in the public arena. While this means continuing the fight against managed care practices and supporting legislative and judicial redress, this campaign aims at a broader “target:” to inform this country that quality mental health care is real, beneficial, and even affordable despite the agitprop offered by corporate America. We need to build back the notion that real mental health care matters. Our incoming president, Deborah Peel, will be the point person for this effort with the goal of raising awareness and quite frankly respect for mental health care and practitioners. This campaign kicked off in the last issue of the newsletter and the current version of the Inform America campaign statement is in the middle of this issue.

Finally, our current president, Karen Shore, and board member Pat Dowds, will develop a companion campaign called “The Myth of the ‘Worried Well.’” Karen has written on this topic before (see her article on our web site) and a current article by Gary Walls in this issue further drives home the point that the corruption of language introduced by managed care has a particular and pernicious intent. The Coalition campaign will expand this battle to the public at large and expose the lies that sustain the myth that quality mental health care is unattainable, prohibitively expensive, or ultimately trivial.

As the Coalition evolves to a new level of advocacy and renewed focus on our core values, it is fitting that we will kick off this effort with, what else, a fundraiser. But, more than a fundraiser, the National Coalition Conference that will be held in New York City on June 22, 2001 will be an opportunity for Coalition members to renew their energy and commitment to our efforts. The conference afternoon is still in the planning stages (we do not have a place yet, although it will be that Friday afternoon) but two events are definite. We will be introducing our new president, Deborah Peel and honoring our founder and departing president, Karen Shore. In addition, Representative Richard Gephardt will be the keynote speaker. He has promised to deliver a major address on the topic of health care reform at this event. This will be a great opportunity to advance mental health care, and bring the Coalition and our advocacy, to the forefront of public awareness. Dick Gephardt’s presence speaks to the energy of our new president in advancing awareness of the Coalition in the public arena, and also is testimony to the value and importance congressional leaders place on quality mental health care.

We need you to come. We need everybody to come. Perhaps the electoral results during the late unpleasantness will introduce movement at the national level and raise the stakes for both parties in an honest debate on the wishes of the American people. One thing is for sure, without a loud and persistent, at times obnoxious, voice, the issue of quality mental health care will be increasingly relegated to where corporate interests wish it to belong: at the bottom of the public policy agenda. (See the series of articles in this issue on the HIPAA regulations and the administrations determination to undermine privacy.)

With the initiatives begun this year, the National Coalition may soon sustain itself financially without total dependence upon the practitioner community. It can never succeed in its mission without active and vocal support from professionals, patients and the general public. Please help us by copying the Journal form at the end of the newsletter and soliciting organizations, professional and nonprofessional alike, to support this conference and the work of the Coalition. If you can devote time, please contact us to assist in staging the conference. If at all possible, be there at the conference on June 22 (don’t worry, you will find out where it will be held in the next week or so, just mark your calendar now). And, as always, send money. Get us “over the hump” to establish a secure financial footing through establishment of the Foundation and hiring an executive director.

I hope I have conveyed some of the excitement and challenge I have experienced during my year on the board. If I have, take the opportunity now to contact the Coalition and offer your support. Do it now! Then get right back and finish reading the newsletter. I worked really hard on it.

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