Professional Standards in Mental Health CareManaged mental healthcare has considerably affected the counselling profession. Managed care guidelines determine whether and how counsellors deliver services and whether services are repayable. Counsellors are particularly challenged when insurance repayment is denied because managed care organisations (MCOs; Danzinger & Welfel, 2001, 137-151; Glosoff, 1998, 8-16) are not honouring codes in the British Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. Rappo (2002, 167-169) emphasised that it is health cost that is being managed versus health care. In this article, we provide an overview of the effectiveness of managed healthcare systems and their impact on mental health counsellors.
We review ethical and legal dilemmas involving informed consent, confidentiality, client autonomy, competence, treatment plans, and termination that had not existed prior to the introduction of managed healthcare systems. We outline the relationship between the DSM and insurance repayment for delivery of services and examine how MCO regulations regarding certain diagnostic codes prompt intentional misdiagnosis of mental disorders for insurance repayment. We provide reasons why insurance repayment is denied based on certain DSM diagnostic codes.
We examine violations of the British Counselling Association's (BCA; 1995) Code of Ethics and Standards of Practice and the British Mental Health Counsellors Association (BMHCA; 2000, 2-22) "Code of Ethics of the British Mental Health Counsellors Association" in relation to intentional misdiagnosis of mental disorders for receipt of insurance repayment, as well as legal consequences surrounding this issue. We consider implications for counsellors and offer suggestions for professional conduct regarding intentional misdiagnosis. During the 1980s, MCOs emerged as an approach to curb spiralling healthcare costs. Burgeoning expenditures involving healthcare maintenance captured the nation's attention to the extent that significant measures had to be taken to control healthcare spending.
Despite efforts made during the 1980s to contain healthcare spending, the UK Department of Justice Healthcare Fraud Report Fiscal Years 1995 & 1996 (1997) indicated that health costs still exceed 1 trillion pounds each year. In general, managed healthcare involves consumers, medical and mental health professionals, hospitals and nursing homes, and mental health agencies that fall under mandates of MCOs such as health maintenance organisations, managed mental healthcare organisations, preferred provider organisations, independent practice associations, and Medicare and Medicaid.
MCOs also define and determine access and delivery of healthcare services, as well as regulate distribution of insurance repayment. Effectiveness and Impact of Managed Care Varying viewpoints exist regarding the effectiveness of managed healthcare during the 1980s and 1990s. Some authors believed that managed care was a realistic method of controlling cost while maintaining quality healthcare (Cummings, Budman, & Thomas, 1998, 460-469). As costs in healthcare increased, so did the number of restrictions placed by insurers on repayment for mental health services. As a result, providers and consumers expressed concerns about diminishing access to needed services as healthcare service delivery moved from traditional fee-for-service providers (e. g., consumers purchased insurance from a commercial carrier, paid a deductible, and chose their physician separately to managed care providers (Huff, 2000, 441-457).
Most mental health counsellors strive to meet MCO regulations (Danzinger & Welfel, 2001), but they do not agree that managed healthcare is effective. Regardless of the answer, results from studies indicated that the majority of mental health counsellors perceived MCO requirements as a negative influence on their practices (Danzinger & Welfel, 2001, 137-151).