Rethinking professional prerogative: managed mental health care providers

Abstract

Managed care represents a response to the wider institutional demand for technical rationality and efficiency. In the US, managed care exemplifies the commodification of health and is governed by a technocratic-rationality that often conflicts with the professionally governed value rationality of providers. Providers must negotiate between contradictory institutional demands for cost containment and quality care in their everyday work practices, and consequently experience a series of ethical dilemmas. This paper examines the effect the commodification of health care has had upon the work of mental health care providers, their loss of professional prerogative, their concrete experience of the ethical dilemmas which result from the commodification of care, and evidence of countervailing power.

The Challenges in Providing Services to Clients with Mental Illness: Managed Care, Burnout and Somatic Symptoms Among Social Workers

“…The overarching goal of managed care organizations is to provide efficient quality care at a lower cost than that offered in the fee-for-service professional community. Social workers as well as other mental health care providers have been required to learn new strategies and skills in order to cut costs of services by limiting access to services and limiting the utilization of more costly services (Cohen 2003;Scheid 2000). New skills involve computers and technology, documentation and paperwork, empirical validation of treatment methods, knowledge of brief treatment modalities, and a business orientation in managing services in a profitable way (Bolen and Hall 2007;Feldman 2001;Lu et al 2002).…”

Norms for priority setting among health professionals: a view from Norway

“…Although the empirical material is from Norway, the issues raised are wider. The analysis has implications for the general discussion about the ongoing commodification of health care (Scheid 2000, Segall 2000, Churchill 1999. By commodification I mean the process by which health care is made more and more exposed to various market mechanisms, and thus turned into a kind of commodity.…”

Conceptualizing structural violence in the context of mental health nursing

“…Our study identifies the implications of ignoring the complexity of need and care in mental health settings, of judging patients in this sector as requiring less complex care, and of according the nurses who provide it with less support, resources or respect as a result. As others have noted (Scheid ), nurses are placed in an untenable position when cost containment strategies contradict their ethical responsibilities. In the mental healthcare setting, nurses' reduced control over their work (and assumptions about this work and who performs it) places them alone in elevators with potentially violent patients.…”