Will managed care ever deliver on its promises? Managed care, public policy, and consumers of mental health services.

Advocates of managed care have promised to greatly improve delivery of services to persons with serious mental illness by focusing on effectiveness and accountability. With the exception of a few beacons of success, experience shows that managed care has not delivered on its promises. This article examines several areas of the public mental health system that still have major flaws, hindering adequate provision of services. Such flaws include the absence of integration of Medicaid and the public mental health system; general lack of publicly documented performance measurements that demonstrate accountability; absence of meaningful and authentic consumer, family, and enrollee participation in service planning, implementation, and evaluation; among others. Are we ready to replicate the lessons from the few beacons of success, or will we just continue to fail persons with the most serious mental illnesses?