The changing job $cene in mental health care
Managed psychiatric health care has altered not only delivery of services, but employment opportunities as well. Social workers and nurses are finding more jobs in managed behavioral health networks, while occupational therapists are finding fewer.
Social workers have been included more under managed care because they provide cost-effective treatment and know how to link patients to good community resources, said Rita Vandivort, ACSW (Academy of Certified Social Workers), senior policy associate for the National Association of Social Workers.
Psychiatric nurse practitioners are also being embraced by managed care organizations. Alan Savitz, MD, president and CEO of PacifiCare Behavioral Health Inc. in Laguna Hills, California, said he seeks out nurse practitioners for his organization because of their effectiveness in treating people with serious mental illnesses and their ability to communicate with interdisciplinary team members.
Enhanced roles for NPs and clinical nurse specialists at the Veterans Administration have lead to greater overall job satisfaction, according to Patricia Brown, MSN, CNS, RN, a nurse manager for the substance abuse treatment units for the Kerrville VA Medical Center. "Now we’re doing what we always knew we could do, like group work, more assessment, and more case management," she said.
But occupational therapists throughout the country haven’t fared as well, said Tana Brown, MA, OTR, chair of the mental health special interest section for the American Occupational Therapy Association. "Managed care has really hurt opportunities for OTs in mental health, primarily due to the short length of stay," she said. OTs were slower than nurses and social workers to establish a place in community mental health, so they are having more difficulty getting reimbursement for outpatient day treatment programs.
Many social workers say that despite the opportunities, managed care is not all good news. "The bad news is the average payment per visit is going down, the average length of stay is going down, and the hassle factor is way up," Vandivort said. The requisite paperwork and authorizations have compelled some social workers to seek patients who pay for their own care.
As more psychiatric treatment comes under the managed care umbrella, more health professionals will be dissatisfied with their jobs, predicts Karen Shore, PhD, president of the National Coalition of Mental Health Professionals and Consumers. "They’re going to have to deal with discharging patients who they really don’t think should be discharged," she said. "I think they’re going to see a lot more revolving doors."