The Issues Facing Ethical Mental Health Care

Address at the Nurses' March on Washington Capitol Building

May 10, 1996

We are all standing together today, Democrats and Republicans; liberals, conservatives, and in-betweens; professionals and consumers, to tell Congress that managed care (MC) is literally killing people and destroying our medical and mental health care system. We will never regulate this industry adequately. We must move America beyond MC and Managed Competition.

Patients and clinicians have become powerless, dominated by greedy, dishonest, and uncaring corporate dictatorships that are taking billions of dollars out of the system at the cost of our citizens' lives and well-being and at the cost of our professions.

Let me say clearly: MC is immoral. MC deprives citizens of three basic rights: the right to choice, the right to privacy, and the right to make their own treatment decisions. Clinicians and hospitals are chosen and retained if they make a profit for the managed care company, not because of their skill, training, or ethics. MC has also brought us an outrageous lack of privacy as detailed information about patients is put into the insurer's computers. This invasion into privacy humiliates and re-traumatizes mental health patients. Clinicians feel forced into betraying their own patients' needs for privacy.

MC's incentives and directives to under treat are immoral. Drastic cuts in psychiatric hospital admissions, lengths of stay, and aftercare has brought an increase in re-hospitalizations, patient injuries and patient deaths due to suicide and the inability of the mentally ill to take care of themselves.

MC has destroyed psychotherapy and replaced it with a superficial model of crisis intervention, usually limiting therapy to about 3-12 sessions, regardless of the problem. Even children are being deprived of psychotherapy and forced to take medications because the insurer wants a quick fix. Money counts. People don't. Managed mental health care will never help us solve our problems with homelessness, psychosis, crime, suicide, teen pregnancy, child abuse, spouse abuse, and the many troubled children who grow up to be troubled adults who raise another generation of troubled children, because MC does not want to spend the money and doesn't care about people.

MC is immoral because it hurts people most when they are vulnerable. People must often fight for proper treatment at a time when they should be spending their energy on getting well or taking care of a sick loved one.

MC has demoralized clinicians who feel forced to be compliant with a system that puts the insurers needs above the patient's needs. Patients can no longer be sure they can trust their clinicians' motives, and clinicians can't even be sure they can trust themselves.

Competition has not brought the highest quality at the lowest price. It has brought a search by the employer for the cheapest policy, and a search by the insurer for the cheapest, least-trained clinicians who are expected to provide the least treatment possible. This, my friends, is a formula for disaster, and it is immoral.

We do not want a system of corporate dictatorship, and this industry will fight our attempts to regulate it sufficiently. We need a system in which our citizens have control over their own lives. We need a system in which clinicians are chosen because they are the best, most highly trained and most ethical they can be, not the "cheapest" and most compliant. We need a system based on compassion, not on the bottom line; and on freedom, not on authoritarian control over patients and clinicians. Whether we have a single payer or a multiple payer system, benefit designs must make the consumer cost- conscious so they can retain their freedom. Cur idea for such a plan is called "Managed Cooperation." Medical Savings Accounts are another idea, and Congress should stop playing politics with it. Some states may wish to experiment with Single Payer plans.

There are many ideas. ...but, Congress: Do not force MC on us. It is a destructive, exploitive, mean system, and we want it replaced. If you continue your love affair with MC, we will hold you, Congress, responsible for every death, for all pain and harm that occurs because of MC. We need you, Congress, both Republicans and Democrats, to stand with us and say "No" to MC and "Yes" to developing and implementing more pro-patient and democratic health insurance plans. Thank you.

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