By Jeannine Mjoseth
Monitor staff

Mental health-care experts and state legislators stressed the importance of supporting quality benefits over cost savings at a Nov. 11 town hall meeting in San Diego?a meeting APA officials see as a prime example of the community outreach psychologists should conduct to generate support for quality mental health care.

The forum on managed care, organized by the San Diego Psychological Association, offered 70 members of the public an opportunity to hear debate by mental health professionals, community leaders and legislators on the future of mental health services under managed care.

?The forum was a success because it raised the awareness level of how managed care works,? said Cheryl Martin, EdD, chair of the SDPA?s professional practice and business committee, who organized the forum with Ain Roost, PhD, SDPA president. In an informal discussion after the forum, for example, one attendee said psychologists should advocate for better mental health benefits because consumers often shy from that role, Martin said. Another attendee chose her new health plan based on comments by the employee-benefits manager present at the forum.

According to Russ Newman, PhD, JD, APA?s executive director for practice, the forum succeeded in stimulating considerable discussion about a variety of issues, including access to health-care services and managed-care cost containment. ?The San Diego event offers a model of community-based dialogue that may be suitable for other state and local psychological associations,? he says.

Community outreach is an important component of the APA?s public education campaign. Among other programs, APA members have conducted national depression and anxiety screenings and made presentations to local Rotary Club chapters and corporations on various issues like workplace stress, Newman says.

?Developing partnerships with the community offers psychologists new venues to apply their skills and an opportunity to educate the public about the value of psychology,? Newman says.

Also on the San Diego panel were California Psychological Association Executive Director Michael Haley, PhD, California Assemblyman Howard Wayne, former State Sen. Lucy Killea, and Cindy Miller, an employee-benefits manager for the Chula Vista elementary school district near San Diego.

The best way to ensure that quality of care is protected in today?s health-care system is through the advocacy efforts of a coalition of mental health consumers, providers and interested organizations, Wayne said.

The coalition, he added, should press for laws that:

? Protect confidentiality of patient information.

? Ensure that mental health benefits are equal to physical health benefits.

? Provide point-of-service options so any willing provider can provide services.

? Require disclosure of plan benefits and utilization criteria.

The coalition also should press for laws that would allow consumers to pursue a legal remedy from managed-care companies that harmed them by denying treatment, Newman said. A federal bill providing millions of patients the right to sue managed-care companies for negligence is pending in Congress (HR 1415).

Managed-care proponents argue they cannot be held negligent because they do not provide health care, but just manage the benefit on behalf of the payer. The courts, however, are beginning to render decisions that cast managed care, and its decisions to approve or deny care, as part of the actual practice of health care rather than simply insurance coverage, Newman said. An Arizona appellate court recently decided that a managed-care company?s medical review director was practicing medicine when he rendered a utilization review decision and, thus, was subject to sanctions by the state medical board. Consumers are in the best position to call attention to decisions that adversely affect their psychological care, but are reluctant because they fear stigmatization and possible job loss if they reveal the fact that they?ve undergone mental health treatment or need additional mental health benefits, Haley said.

Employers do not recognize that they lose money through lost productivity and absenteeism when employees have mental health problems such as stress and depression, Newman said.

?We have 30 years of research that shows if you treat a mental health problem early, you incur less overall health-care costs,? Newman said. ?But providers have not been able to put that into a language that employers can understand.?

Employers are providing the best health benefits they can given their fiscal responsibilities, and should be commended for providing consumers such valuable services as side-by-side comparisons of plans that they can choose from, said Miller, the benefits manager.

Without concerted advocacy efforts, some panel members predict a continued slide towards health care that emphasizes costs over quality. ?As competition intensifies, I don?t see things getting better,? Wayne said. ?I see greater pressure to cut costs, to hire contract employees and to provide fewer benefits to fewer employees.?