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Book Reviews   |    
Managed Behavioral Health Services: Perspectives and Practice
Reviewed by Robert K. Schreter, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.9.1075
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edited by Saul Feldman; Springfield, Illinois, Charles C. Thomas Publisher, 2003, 435 pages, $77.95

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The pace of change in managed behavioral health care has been so rapid that, a mere 15 years after this system of care took hold, a book titled Managed Behavioral Health Services: Perspectives and Practice could have been titled "Managed Behavioral Health Care: A Retrospective" or "Managed Behavioral Health Care: A Requiem."

The edited volume includes 15 chapters selected, in part, to highlight the positive contributions of managed behavioral health care. The editor, Saul Feldman, is one of the founders of the managed behavioral care movement and industry. He began his career in academics and as director of the community mental health centers program at the National Institute of Mental Health. He went on to start United Behavioral Health, the nation's third largest managed behavioral health organization, responsible for nearly 20 million covered lives. Contributors to this book are prominent members of industry, academia, and consulting. The articles are thoughtful, balanced, based on data to an unusual degree for this type of discussion, and often scholarly.

Of particular value to the reader is the choice of topics. Some chapters review areas that have been widely discussed, including effect on clinical practice, law, physical health, public sector, and training. Others deal with topics that have received less attention and are less well understood by many, including clinical risk management, quality management, employers' perspective, and employee assistance programs. A particularly interesting chapter reviews the literature on the impact of managed behavioral health care on spending, quality, and access; how savings are achieved; and the not-well-recognized, confounding economic variables that make it difficult to draw firm conclusions. A third set of chapters on information systems and services research address areas that have yet to achieve their potential for using managed care's vast reach and massive database to contribute to efficient, effective, evidence-based clinical and administrative services.

Three perspectives not included in the book are those of practitioner or facility providers, consumers, and employer or government payers who are on the receiving end of the consumer backlash. This omission should come as no surprise. Dr. Feldman is exercising his editor's prerogative and presents viewpoints that best represent his own.

Managed care is a profoundly polarizing topic, with managers and chief financial officers on one end and many consumers and providers on the other. This book is recommended reading for all who occupy a position on this continuum—clinicians of all specialties, consumers, employer and government payers, and policy makers. The essays will be particularly enlightening to clinicians, consumers, and managed care critics who are less familiar with managed care's own view of its role and responsibilities and the expectations and motives of the private and public payers who hire managed care organizations and evaluate their performance.

The competition for scarce resources between mental health and physical health and between health care and other social claims will not go away. Managed Behavioral Health Services: Perspective and Practice is an important contribution to the understanding of the challenges that confront the designers of our health care system of the future.

Dr. Schreter is clinical associate professor at the University of Maryland School of Medicine and medical director at Future Health Corp in Baltimore.




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