Health Policy Debated By Experts at K-School

Roughly 60 national experts debated the impact of privatization of mental health care in America yesterday at a conference sponsored by the Kennedy School of Government's Center of Health and Human Policy.

The one-day conference, regarded as an innovative integration of medicine and public policy, revealed a framework for a national treatment plan for mental illness.

Researchers also released results from a federal study of corporate ownership and mental health care.

"[It was] intended to talk about mental health care in public and private hospitals and the contributions of private care," said Robert A. Dorwart, executive officer of a K-School working group on mental health policy, speaking of the summit.

Called "Privatization of Mental Health Care: A National Perspective," the conference revealed mixed responses to what researchers have called the "megatrend" of privatization. For-profit corporations in 1986 provided 15 percent of all nonfederal psychiatric care, up from 1 percent in 1970, researchers say.

Speakers on three panels yesterday generally agreed that while the profit motive has hampered care, some sectors of the public have benefitted.

"Private hospitals are operating in a highly competitive environment," Dorwart said, "If you've got to worry about going bankrupt, that will affect care."

However, growing private health care has expanded access for some groups, particularly children and drug addicts. Others, however, such as the seriously mentally ill, have lost out as their treatment programs become less profitable, researchers said.

In a fourth panel, Dorwart and Assistant Professor of Social Medicine Mark Schlesinger presented a study sponsored by the National Institute ofMental Health (NIMH).

The study, based on surveys of hospitals,community health centers and privatepsychiatrists, asked about the ownership ofhospitals and health care facilities by largecorporations and how open competitive marketsaffect mental health care.

The study found evidence of rapid privatizationand increase in inpatient services the pastdecade, but warned of a trend toward a"three-tiered", income-based system of access tohealth care. It predicted a slow-down, however,and warned of funding shortages and shake-outs inthe health industry.

NIMH Senior Science Advisor Ira D. Glick alsopresented a national plan to combine public andprivate mental health services in the battleagainst severe mental illness, particularlyschizophrenia.

"The problem is there is inadequate treatmentbecase of inadequate resources in an inadequatesystem," Glick said in the presentation. "We needa strategy to develop new research to maximizeeffective treatment." Several NIMH committees haveconvened to organize strategy, Glick said, and theresults are being refined.

Conference attendees included K-School members,doctors, representatives of for-profit andnon-profit private hospitals and publicinstitutions and representatives of a mentalhealth care consumer group.

Speaking for consumers, Harvard Divinity Schoolgraduate and executive director of the Alliancefor the Mentally Ill, Geoffrey Brahmer criticizedthe need for profit motives.

"Don't let the language of accounting, ofbusiness win out over the language of human need,"Brahmer said.

The conference was held at the K-Schoolbecause, "Mental health care is a concern ofgovernment because it is a big investment of thepublic. This is one of the few schools ofgovernment that anyone is talking about mentalhealth," Dorwart said.

A future conference was mentioned but notplanned. "If we were to have a next section, thetopic would be how do we get the public andprivate sectors together," said Dorwart