Integrating Mental Health Services through Reimbursement Reform and Managed Mental Health Care

Abstract

People with serious and persistent mental illness require a range of community services typically provided by different specialized agencies. At the clinical level, assertive team case management is the strategy commonly used to achieve integration of services across specialized sectors. The USA also has used various financial and organizational approaches to reduce fragmentation and increase effectiveness, including development of stronger public mental health authorities, use of financial incentives to change professional and institutional behavior, requirements to allocate savings from hospital closures to community systems of care, and introduction of mental health managed care on a broad scale. These approaches have potential but also significant problems and there is often a large gap between theory and implementation. These US developments are discussed with attention to the implications for mental health services in the UK.