Evolutions in utilization and quality management. A crisis for psychiatric services?

Psychiatric services have evolved into another time of crisis. Following a 30-year period of growth in psychiatric science, services, and benefits, payors are now retracting and restructuring funding for services they believe are no longer affordable. A number of utilization and quality management initiatives have been instituted to reduce avoidable outlays--some promising and many with deleterious consequences. The precise directions that future competitive and regulatory influences will take in affecting availability and quality of psychiatric services remain unclear. Managed mental health services now appear to be gaining favor with payors because of their use of professional case management resources. Other cost control initiatives do not appear so favorable to psychiatric services.