AACP Newsletter, Volume 10,
Number 3, Summer 1996
A Progressive Vision for Community Psychiatry in the Twenty-First Century
As the community mental health paradigm becomes increasing central to the operations of the private sector behavioral healthcare enterprise, community psychiatrists and community behavioral health professionals are working in many ways to define and sustain a progressive vision for community psychiatry in the 21st century.
In response to the Editor’s Column written by Dr. Ken Thompson in the Winter 1996 edition of this newsletter, I would like to submit the following three principles for consideration for this process:
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MOBILIZE AND CHANNEL MARKET FORCES TO ACCOMPLISH SOCIAL POLICY OBJECTIVES
In response to taxpayer preferences, the democratic party is leading the most significant downsizing of government agencies since World War II, accompanied by massive tax cuts intended to balance the federal budget. Within this context, it is unrealistic to imagine that many of our cherished social policy objectives can be accomplished through government sponsored programs and services.Consequently, it is imperative for progressive community behavioral health professionals to understand the new economic realities and master skill sets that are required to achieve desired social policy objectives within this context. Specifically, it is incumbent upon us to mobilize and channel market forces in such a manner that goals such as universal coverage, benefit portability, enhanced access, improved quality, improved outcomes and long term disease management become rewarded by the privatized healthcare systems that are currently in favor with the American taxpayer
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OVERCOME COMMODIFICATION THROUGH VALUE-BASED PRICING
Within a market-driven economy, high-value products and services achieve positions of market dominance. It is incumbent upon us to resist and overturn the downward price pressure on behavioral health services through adopting value-based pricing strategies. In order to do this, we must improve our effectiveness at value measurement, value enhancement, and value communication methods as these pertain to behavioral healthcare.Within this context, value will be determined by the needs of the two stakeholders that will shape the evolution of market based healthcare systems. There are the purchasers, (taxpayers, self-insured employers, etc.) and the customers (direct consumers of behavioral health services). All other parties to this equation, including health plans, providers, and government agencies, are interest groups, not stakeholders.
To be competitive, interest groups must learn how to add value to stakeholders rather than focusing their efforts on protection of their own self-interests. The experience of other industrial sectors suggests that failure to stay customer focused in this regard will lead to the ultimate obsolescence or irrelevance of the non-stakeholder interest groups in the behavioral healthcare equation.
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DEFINE AND ADHERE TO ETHICAL PRINCIPLES
As we mobilize and channel market forces in a manner that rewards value, we must also be mindful of the values that are central to our endeavors. The community and professional values and the ethical principles that frame the infrastructure upon which behavioral health systems are built require clear articulation and protection. To protect these values, progressive community psychiatrists must “push back” on, and demand the partnership of other community interest groups. For example, it will be much more difficult for community behavioral health professionals to mitigate domestic violence in the context of a state government that refuses to control or outlaw firearms.
In closing, I wish to extend my appreciation to the American Association of Community Psychiatrists for covering the Behavioral Healthcare Tomorrow national dialogue conference and for publication of these remarks. These comments reflect my own perspectives, not those of the Institute for Behavioral Healthcare. Whatever your own personal perspective may be, I certainly encourage your continued participation in the national dialogue process which is required to reach consensus about the overall objectives that will drive the evolution of behavioral healthcare products and services in the 21st century.
Michael A. Freeman, MD
President
Institute for Behavioral Healthcare
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