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Book Review   |    
Controversies in Managed Mental Health Care
Jeremy A. Lazarus , M.D.
Psychiatric Services 1998; doi:
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edited by Arthur Lazarus, M.D.; Washington, D.C., American Psychiatric Press, 1996, 427 pages, $58.50

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Catching the essence of controversies in managed care is like aiming at an elusive target with a constantly changing shape. The editor has assembled an open-minded and varied group of contributors who address difficult questions about practice, policy, clinical aspects, utilization review, research, training, administration, management, and health reform. Each of the 27 chapter titles is formatted as a question—for instance, "Are Practice Guidelines Useful in Managed Care?" "Who Decides What Is Medically Necessary?" and "How Should the Profit Motive Be Used in Managed Care?"

The editor, who has written extensively about managed care, asks whether we really need another book on the subject. We do need this book, as the questions it raises are thoughtful, yet practical. The general tone of Controversies in Managed Mental Health Care is of attempting to deal with, cope with, or adapt to managed care. This perspective offers a strength for professionals who spend a good deal of their lives treating patients in or through managed care settings and for those struggling with these questions. Administrators, in particular, may find the content interesting as they deal with these conflicted areas on a daily basis.

Although the chapters are primarily written by physicians, the structure and content of the book makes it of value to all mental health professionals. The chapter authors demonstrate expertise and real-world experience as they tackle thorny administrative, clinical, or professional issues. Some chapters rely more on factual material, and others more on passionate beliefs of one kind or another. This variety presents an interesting mosaic from which readers can choose pieces to follow up further or perhaps to disregard.

The book provides less direction for professionals who are resistant to, antagonistic toward, or unconvinced about the benefits of managed care or who are in some way looking toward other solutions for the health care crisis. Nevertheless, the book can provide a structure to help those readers explore different solutions. Although answers to many of the questions that are posed cannot be definitive or final, the inclusion of more critical views from those who are not in the camps of coping with or adapting to managed care might have provided an interesting counterpoint. Perhaps such perspectives could be part of a next edition of controversies.

Some of the areas of managed care that are of greatest concern to mental health professionals—the role of science and attention to treatment research findings, the ethics, and the business motivations—could have received more attention. The field needs ongoing exploration-subjective and objective, scientific and lay, professional and political—to sort through the controversies in these and other areas in the spirit of quality improvement. Recognizing the trends of managed care as realities of the times and attempting to address difficult issues head-on can only serve to shed light on this murky and often problematic subject. Controversies in Managed Mental Health Care will assist us in that pursuit.

Dr. Lazarus is associate clinical professor of psychiatry at the University of Colorado Health Sciences Center in Denver.




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