New Mental Health Reform Plan to Be Unveiled at APA Meeting!

We’ve got to act wisely and otherwisely.–Allen Lamport, mayor of Toronto, from April 2/3 calendar, “365 Stupid Things Men Have Said (But We Love Them Anyways)”

On April 1, a secret source let me in on a special addition to the new “Obamacare” healthcare reform law, which just had its 1-year anniversary. It will be released by the new Convocation speaker at the upcoming annual American Psychiatric Association (APA) meeting in May.

Now, that’s another secret. You may know that Archbishop Desmond Tutu of South Africa was supposed to be the speaker. However, his alleged anti-Semitism caused Thomas G. Gutheil, MD, a Distinguished Life Fellow of the APA, and other psychiatrists to resign from the APA and threaten to picket the meeting. You actually may have read about it in the reprint of his letter of resignation that appeared in Psychiatric Times.

Someone then came up with this brilliant idea. Since Tutu once advocated for international private, for-profit managed care, let’s replace him with one of the pioneering managed care executives, Apryl Fule, who has spent some of her most generous salary and stock options on buying a place in Hawaii, where she can lie in the sun and daydream of the next managed care strategy. Obviously, the payers of insurance, like businesses and the government, want a new way to reduce costs that resulted from the recession and Republican political priorities. Utilization review, authorization, formularies, and wellness have all run their course. Psychiatry had always been the easiest target, so some new frontiers readily came to mind. She couldn’t wait to tell all those psychiatrists at the meeting, unless they were held up by the picketing.

Diagnosis
Apryl has been noticing that it looks like the upcoming DSM-5 will have even more disorders to diagnose. She also heard that it will still be open to any mental health clinician who can claim “a body of knowledge and clinical skills” obtained through “specialized clinical training,” despite the alternative recommendations of a Dr Moffic to designate psychiatrists as the primary diagnosticians. Actually, Apryl thought to herself, I’m glad Dr Moffic’s recommendation is being ignored. We might have to pay psychiatrists more than others to do the evaluations, since if they obtained some monopoly on this process, they could even demand-and likely receive-higher reimbursement for doing the diagnosing or supervising others to do so.

But Ms Fule thought she could do Dr Moffic one better. Given all the information available on the Internet, and if the criteria continue to look like a cookbook without any confirming biological tests, then why not open up the diagnostic process to the public? She bet the APA would like this, too. Think of the sales! The APA would be flush with cash in a time of constriction. Just like Pharma advertises medication on various media, this APA could advertise “Psych Yourself Out: How to Diagnose Your Own Disorder”!

And, what a financial boon it also might be for the insurance companies. They won’t have to pay so many professionals for a diagnostic evaluation, and to help would-be patients along, they can send them free DSM-5 manuals (which in turn will further increase sales for the APA!).

Network
Apryl wondered, why don’t we formally include self-help groups in our next network and authorize them to be tried first? For certain cultural groups, we could also refer to folk healers like witch doctors and curanderos, who only expect a small donation. Next up for the religiously inclined would be to try pastoral counseling, and contribute to their “discretionary funds.” All of this would make our networks more comprehensive.

For the more seriously and chronically mentally ill, the consumer-driven recovery movement couldn’t be more cost-effective for our purposes, could it? Even if some consumers were paid for the peer help, they could be quite low on the salary scale, but be grateful for any opportunity to have some work and make some money.

Treatment
The American Journal of Managed Care can become the arbitrator of best practices. This journal, which Apryl just happens to edit, balances any problematic conflicts of interest. Instead of other psychiatric journals relying on Pharma for advertising, here we also have the support and influence of profitable managed care companies. On March 16, we (I mean, they) announced the availability of the presentation “Best Practices and Innovative Reform Models.” Passing a test on its content is a prerequisite for following its treatment guidelines.

For depression, they recommend taking Ecstasy. Yes, we know its illegal, but we can confidentially refer the patient to a cheap source.

For presumed Bipolar Disorder, aka “Manic-Depression,” we recommend lots of roller coaster rides, where one can enjoy going up and coming down without any dangerous outcomes (unless, of course, the roller coaster gets stuck or breaks).

For Attention Deficit Disorder, there’s so much diversion of stimulant medication on university campuses that you can just go to your local college and buy some on the black market.

Now, if anybody is angry at these changes, we have this new Anger Management Program. Vent your spleen by squeezing the left side of your stomach until you calm down.

Other new treatment recommendations are on the way. You get the picture. Do you have any suggestions for us?

Follow-Up
In the meanwhile, maybe we should hire the Archbishop Desmond Tutu to be our organizational consultant and set up a Truth and Reconciliation Commission for For-Profit Managed Care Companies. The findings could be presented at next year’s meeting. No fooling!?