INTEGRATING MENTAL-HEALTH INTO A GENERAL HEALTH-CARE SYSTEM

To implement the proposed Clinton mental health benefit for the year 2 001 requires a capacity to manage a flexible, comprehensive benefit. I f fragmentation of services and discontinuity of care are to be reduce d, mechanisms must be developed to coordinate services among domains-b etween acute and chronic care, and among public and private providers. Evidence exists that basic mental health services generally can be ma naged in health maintenance organizations (HMOs) with considerable cos t savings and without detrimental effects on health, but it is less cl ear whether this is true of services for persons with severe and persi stent mental illness. Effective services for persons with severe disor ders require a capacity to organize and manage services across broad m edical and social areas, but anticipated costs encourage providers to narrow the scope Of care they offer and to select low-risk patients. M uch will depend on developing methodologies that allow providers to be reimbursed accurately in relation to risk and that protect small prov iders from the potential cost of acquiring too many high-risk patients .