Preface: Before I went to the American Psychiatric Association, many on this webzine expressed interest in my presentation to come on “Human Rights and Managed Care”. Given that interest, and how it may relate to some of our blog discussions, I thought I would post it for my blog. In a way, it is like Laura did in posting her most moving speech from the APA protest; I wish I could have been there at the time, as I would have liked to be as supportive as possible. Maybe next time. Of course, the content of my talk, put together well before I became involved with Mad in America, is much different. I also do not think anybody connected to this site attended our Symposium on Tuesday. By the way, I was also part of the presentation on Monday of a Humanitarian Award to Robert Jay Lifton, sponsored by the American Association for Social Psychiatry (for which I was a Past President). The AASP has long championed addressing the social issues involved in mental health and mental healthcare. Robert Jay Lifton is the award-winning writer who wrote about thought control, Nazi doctors, and led protests against the Viet Nam War. His recent memoir, Witness to an Extreme Century, is superb in my opinion and relates to the concerns on this site.
I’ll need to post my speech in several parts because it is way too long for just one. I’ll do this over the next week or so to keep the connections apparent and allow for discussion along the way. No references are provided, also for space concerns. And, of course, a speech usually doesn’t work as well when it is written out, so my apologies in advance for the writing. However, in terms of being open, I wanted to relay as close as possible what I said.
For those who are not familiar with what “managed care” refers to, it is the dominant way that healthcare and mental healthcare has been provided in the USA (the only country to do so) over the last 20 years. If any of you have gone for healthcare during this time, what you were able to receive likely was greatly influenced by a managed care company, which is in turn paid by the government or businesses. This system of review and authorization has had a major impact on psychiatrists emphasizing medications and spending less time with patients, as well as any clinician not being able to provide a lot of psychotherapy or alternative services (if they want to be paid by the insurance coverage). These for-profit managed care companies are very large. For example, United Healthcare covers over 80 million people in the USA.
This insurance mechanism will increase if President Obama’s healthcare reform continues to emerge, and not struck down by the Supreme Court. If we want healthcare and mental healthcare that is provided under private insurance, Medicare, or Medicaid to improve, this part of the system will need to be addressed. I think relating it to human rights is one way to do so.
Let us start off with a straw poll and vote:
1. Raise your hand if you think that managed care hinders human rights.
2. Raise your hand if you think that managed care benefits human rights.
3. Raise your hand if you think it does both.
4. Raise your hand if you think it does neither.
(If we get enough answers on this blog, we can tally them and compare to what I got at the meeting; my answer will be apparent as we go along).
There is a handout available that copies the 1948 “Universal Declaration of Human Rights”. What I want you to quickly see, if you already have not, is the introduction, for it gives the case of why these rights are important to be known well by us, our patients, and the public. Here are some excerpts from this introduction.
“All human beings are born with equal and inalienable rights and fundamental freedoms. . . In the Universal Declaration of Human Rights, the United Nations has stated in clear and simple terms the rights which belong equally to every person. These rights belong to you. They are your rights. Familiarize yourself with them. Help to promote and defend them for yourself as well as for your fellow human beings.”
(To be continued in Part 2)