Manage or Perish? The Challenges of Managed Mental Health Care in Europe

"Adapt or perish, now as ever, is Nature's inexorable imperative. " -H. G. Wells, Mind at the End of Its Tether (1946) Doctors are trained to treat people suffering from various diseases. This is the main form of their activity and usually the reason for which they selected medicine as their profession. The notion that they should become managers and engage in activi­ ties such as programming, calculating cost, assessing cost-benefit ratios, and thinking about pricing in accordance with the social utility of their intervention, is both foreign and abhorrent to them. They are sometimes willing to say how much they need in order to have a well-functioning service: usually they prefer to state what specific apparatus and other things they require without specifying the price of their demand. They can be persuaded to add a price tag to what they think is necessary for their work: but that was about as far as they would go, until recently. The growing emphasis on human rights over the past few decades, the greater emphasis on quality of life and the public's heightened expectations about their health led, in many industrialized countries, to a greater demand for health services. This, com­ bined with improved possibilities of diagnosis and treatment (at higher cost!), led to a significant increase in financial demands which made governments and health-care systems uneasy and ready to accept any solution that would stop the spiral of seem­ ingly endless cost augmentation.

I. General Aspects.- 1. Understanding Managed Care: A Primer for the World Psychiatric Association “Congress Manage or Perish”, Geneva, Switzerland.- 2. The Future of Psychiatrists under Managed Care.- II. The U.S. Experience.- 3. For-Profit Managed Care in the USA: Growth and Decline?.- 4. The American Experience with Managed Care: How Europe Can Avoid It.- 5. Managed Care and American Psychotherapy.- 6. Private Practice and Managed Care: The American Experience.- 7. Health Economics and Services for Children with Mental Health Problems in the USA.- 8. Is Psychiatric Rehabilitation Something Special to Managed Care in the USA?.- III. The European Versions.- 9. Introduction to Plenary Session II “Managed Care in European Countries”.- 10. Managed Care in Europe.- 11. Transcultural Perspectives of the Management of Mental Health Care: Challenges in Europe and in Low-Income Countries.- 12. Managed Mental Health Care in the UK.- 13. Managed Care in Germany.- 14. Managed Mental Health Care in France.- 15. The Minimal Psychiatric Summary (M.P.S.) and the Current Organization in Mental Health Care.- 16. Minimal Psychiatric Summary: The French Way.- 17. Managed Care in Scandinavian Countries.- 18. Manage or Perish: The Situation in Switzerland.- 19. New Models of Financing: What Is the Future of Psychotherapy in Switzerland?.- 20. The Provision of Mental Health Care in the Russian Federation.- 21. Functional and Dysfunctional Aspects of the 1990 Reform of the Health-Care System: Hungary in 1998: Before Managed Care.- 22. The French Public Psychiatric Team Confronted with the Demand for New Collaboration: A Space for Rehabilitation.- 23. The German Social Insurance Program’s Role in the Rehabilitation of Mentally Ill Patients.- 24. Models of Health Care Systems in Europe: Their Consequences for Psychiatric Care.- IV. Experience in Other Countries.- 25. Managed Care and Quality Assurance Methods in Mental Health in Latin America.- 26. Almost a Revolution: Towards Managed Mental Health Care in Israel.- 27. Challenges of Managed Mental Health Care in the South-East Mediterranean Region.- 28. Cost Management of Mental Patients’ Care: Is Traditional Healing an Alternative in Developing Countries?.- V. Managed Care and Specific Mental Disorders.- 29. Quality of Life Assessment in Schizophrenia.- 30. Traditional Methodology and Outcome Assessment in Studies on the Course of Schizophrenia.- 31. Comparison of Antipsychotics in Randomized Clinical Trials: Economic and Quality of Life Outcomes.- 32. Methodological Problems of Schizophrenia Trials in Community Settings.- 33. Antidepressant Use and Clinical and Economic Outcomes in a Primary Care Psychiatry Center in Spain: A Review of a Naturalistic Study.- 34. Assessment of the Impact of Long-Term Lithium Prophylaxis on the Course of Bipolar Disorder: Methodological Problems and Empirical Data.- 35. Cost Effectiveness in the Prevention of Suicide.- 36. Economic Aspects of Anxiety Disorders.- 37. Cost and Management of Bipolar Disorders.- 38. Major Depression: Brief versus Long-Term Treatment.- VI. Methodology.- 39. From Supply and Demand to Need and Demand: Service Planning and the New Epidemiology.- 40. Outcome Measures and Cultural Factors in Managed Care: A Literature Review.- 41. Use of the EPCAT Model of Care for Standard Description of Psychiatric Services: The Experience in Spain.- 42. Total Quality Management in Mental Health: A Pilot Program.- 43. Research and Communication of Mental Health Data: Three Years on the Net.- 44. Assessing Psychotherapy Outcome: The State of the Art.- VII. Ethical Issues in Managed Care.- 45. Ethical Problems in the Practice of Psychiatrists under Managed Care.- 46. Managed Care: Will it Destroy the Doctor-Patient Relationship?.- 47. Does Managed Care Threaten the Therapeutic Relationship? or When a Third Party Comes between a Doctor and Patient.- 48. When the Therapeutic Team becomes Dysfunctional because of Managed Care.- 49. Cherish or Perish: The Values of Private Psychiatry.- 50. Ethical and Legal Dimensions of Medical Confidentiality in European Law of Human Rights.- 51. Care of People with Psychiatric Subthreshold Disorders: Ethical Challenges.- 52. Ethical Committees as a Guarantee of Observation of Human Rights in Managed Care Systems.- VIII. Managed Care and Psychiatry’s Users.- 53. Unmet Needs and Cost Containment: A Non-Linear Relationship.- 54. The Patient’s View of Managed Psychiatry.- 55. The Young Psychiatric Patients’ Rights: An Overview of the Current International Legislation.- 56. Manage or Perish, or Choosing to Live without Neuroleptic Drugs: Difficulties and Chances.- 57. What the Patients Tell Us: A Preliminary Report on the GAMIAN International Survey, with Specific Reference to the Italian Data.- 58. The Role of Advocacy in an Era of Managed Care.- 59. Alternatives to Psychiatry and Managed Care.- 60. A Cost-Effective Strategy: The Role of Support Groups in Helping Depressed Patients.- 61. Practicing Treatment with Informed Consent: The Possible Impact of the Managed Care Concept.- IX. Teaching and Research.- 62. How Could Academic Psychiatry Survive Managed Care?.- 63. Is Managed Care Good for Research and Education?.- 64. Implications of Managed Care for the Training of Psychiatrists.- 65. The Impact of Managed Care on Residency Training in the Americas.- 66. Maximizing Research Opportunities in Today’s Managed Care Environment.- 67. Unexpected Advantages in Service Design and Research from Cost-Containment Strategies.- 68. Standardized Service Assessment in Italy.- 69. The Andalusian Case Register for Schizophrenia: An Attempt to Obtain Patterns of Use of Mental Health Services for Planning Medical Care.- X. Interference of Managed Care with Social Support Networks.- 70. Support Functions of the Social Networks of Psychiatric Patients and the General Population.- 71. Reduction in Costs but Increased Family Burden: Home Care of the Mentally Ill: The Role of Family Environment.- 72. Social Networks and Health Burden on Care-Givers: A Challenge for Managed Care.