Clinician Experiences of Managed Mental Health Care: A Rereading of the Threat

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Abstract

The threat mental health professionals perceive in managed care, as indicated by their writings on the subject, is re-examined in light of evidence from an ethnographic study. Fieldwork focusing on clinician experiences of managed care was carried out at an urban community mental health center. Existing explanations of “the threat”—the possibility of deprofessionalization and the potential for deterioration in the quality of care—proved inadequate to account for the power it wielded at this site, perhaps because its full impact had yet to be felt at the time of data collection. A “rereading” suggests the meaning of managed care for this group of clinicians lies in the prospect of being gradually, unknowingly, and unwillingly reprofessionalized from critics into proponents simply by virtue of continuing to practice in a managed care context, and in losing a moral vision of good mental health treatment in the process.