Am J Psychiatry 1988; 145:24-28
Copyright © 1988 by American Psychiatric Association
High users of outpatient mental health services, II: Implications for practice and policy
HH Goldman and CA Taube
Division of Biometry and Applied Sciences, NIMH, Rockville, Md.
Four assumptions underlie the stereotyped view of use of outpatient mental
health services: 1) all use is alike, 2) any use leads to high use, 3) all
high use is discretionary, and 4) insurance encourages excessive use. The
authors refute the first three assumptions and suggest that different types
of treatment episodes vary in their responsiveness to price. Diagnosis
appears to be a poor indicator of inpatient needs; some coverage limits
outpatient benefits according to type of treatment. The authors favor a
combination of pricing strategies, as well as case management and clinical
review for high users, which would not impede initial treatment but would
limit excessive use of mental health services.
