(February 1999)

The New York Times has recently published two letters from Chapter leaders, both warning of the consequences of reduced access to mental health benefits.

The first, from Chapter Executive Director Robert Schachter, was written in response to a front page article, "Insurance Plans Skirt Requirement on Mental Health." The second, by Board Member Sue Matorin responded to articles about a young woman who was pushed to her death in front of a subway by a man with a history of severe and persistent mental illness. The two letters are reproduced below.

Your Dec. 26 front-page article does not take into account a more insidious method of reducing access to mental health benefits - reducing the fees paid to practitioners.

Last month two major managed care organizations notified social workers, psychologists and psychiatrists that reimbursement for outpatient services would be reduced by as much as 30 percent. Since fees were already well below the customary and reasonable rates, such reductions are likely to compel the more experienced practitioners to resign from these networks.

People in need will find their selection of the most qualified professionals extremely limited. Many employers paying for the coverage are unaware of the reductions. Where are the Federal and state oversight agencies?

Robert Schachter
New York, Dec. 28, 1998

We grieve two lives of promise, one interrupted by a history of mental illness (editorial, Jan. 8). Dry policy issues like the city-state struggle over financing of supervised housing for psychiatric patients, the unmet needs of the disturbed among the homeless in shelters, and the sluggish effort to achieve insurance parity for mental health care all take on a human dimension when something like this occurs.

Providers make life-and-death decisions while we cope with our anxiety about the impact of corporatization on our practices. Institutional downsizing, substitution of senior clinicians with less expensive novice staff, and pressures to increase clinic volume may balance the budget or even turn a profit. While such shortcuts achieve business goals that are perhaps desirable in other arenas, they should never be acceptable in the care of the severely ill.

Sue Matorin
New York, Jan. 8, 1999