By Ben Joravsky
In Sally’s case, that meant almost daily visits. “I was falling apart,” she says. “I was working 12 to 14 hours a day overseeing the staff and budget of a small business, my parents were struggling with serious illnesses, and I was dealing with a lot of painful memories of domestic violence and family alcoholism. I began to self-mutilate myself and to threaten to hurt myself. I cut myself. My roommate took me to the emergency room and they told me they didn’t have any beds in the psych ward–no room at the inn, so to speak. The doctor’s main question was whether I could keep myself alive long enough until tomorrow, when I could go to an outpatient place called Spectrum. That’s the first I ever heard of it.”
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Sally didn’t know that her rock was sinking. In its last seven years it passed from one manager to another. “We went from different managed care systems,” says Red, “from Reese to Humana to Advocate to York Behavioral Health.” Each transition brought a new set of guidelines having to do with cutting costs. “There were gradual cutbacks,” says Red. “It was pressure to cut costs. I think we did a good job of keeping it from our patients.”
Scholom says fewer people are receiving mental health care because fewer policies cover it. Patients either pay out of pocket or go without. “The idea behind insurance has changed with managed care,” says Scholom, who’s also chairman of the Illinois Coaltion of Mental Health Professionals and Consumers, an advocacy group. “It’s no longer pooled risk. Instead it’s what they call ‘capitation.’ Basically, that means that the incentives are not to provide care. The ‘provider’–to use their term–gets a certain amount of money to serve a certain amount of patients and no more. Capitation shifts the risks to the practitioner. That makes you more of an adversary to your patient. It’s harder and harder for a provider to provide service. You have to justify everything. The managed care people will say only four visits. Well, maybe the patient needs more than that. You find yourself on the phone fighting with the insurance company.”
