Letter

"Consumer-Directed Care" and Systems Transformation

To the Editor: In the March 2007 issue of Psychiatric Services, LaBrie and colleagues ( 1 ) discussed the advent of consumer-directed care and inherent difficulties in its application to mental health care services. From the perspective of the majority of consumer advocates, "consumer-directed care" is a misnomer for this form of systems transformation. The apparent focus of consumer-directed care as defined by "scholars, policy makers, and members of the health care industry" ( 1 ) is on cost-cutting without due attention to the standard of care provided and health outcomes.

LaBrie and colleagues correctly point out that this systems transformation, if left unaltered, will likely lead to fewer individuals' seeking care, greater mental and physical health problems left untreated, confused consumers who do not have the necessary information to make informed health care choices, and greater self-stigmatization (which, in and of itself, will lead to poor health outcomes). The last thing that most consumers of mental health care need is to be made "aware of the costs of care," as many consumers are painfully aware of these costs already.

As an alternative to the so-called "consumer-directed care" movement, the recovery model and the patient- and family-centered care model offer an alternative that may be more cost-effective and more clinically efficacious. From a recovery perspective, true consumer-directed care centers on the promotion of empowerment, individualized and person-centered care, hope, and strengths-based care, among other concepts important to consumers of care and their advocates ( 2 ). Interventions such as supported employment, assertive community treatment, illness education, and family education and support are not widely available to consumers of mental health services. LaBrie and colleagues also underestimate the ascendance of peer-support services in mental health care ( 3 ). These recovery-based interventions are designed to provide a more holistic, more collaborative, and more person-centered form of care than traditional, medical-model treatment ( 4 ).

Surely, the costs of mental health care (and health care in general) would fall if these evidence-based practices were widely available. Restricting access to such services through increased deductibles is antithetical to true consumer-directed care.