A BRIEF MEDICAL NECESSITY SCALE FOR MENTAL-DISORDERS - RELIABILITY, VALIDITY, AND CLINICAL UTILITY

Managed care organizations (MCOs) use the concept of ''medical necessi ty'' to decide whether a prescribed treatment is warranted for a given medical condition. Because mental disorders lack the objective diseas e criteria common to medical illness, behavioral health administrators need a validated means to identify and quantify the severity of ''med ically important'' aspects of mental disorders. The authors developed and rested a brief medical necessity scale for mental disorders in 205 patients presenting for initial evaluation. The scale had a factor st ructure with four subscales; good internal consistency, interrater rel iability, and concurrent and predictive validity; and modest ability t o identify patients requiring hospitalization and, in hospitalized pat ients, those requiring involuntary hospitalization. The authors propos e use of the scale to better clarify decisions about level of care ass ignments and to better assess patient characteristics predictive of go od outcome.