Managed Care for Mental Health

By Nathaniel Counts

Managed care and integration of primary care and mental health services are major foci of the Affordable Care Act, especially as more practices are encouraged to become Patient-Centered Medical Homes.  In managed care, vitals are used to track progress, and case managers can look over an individual’s blood pressure, weight, and blood-sugar levels to work with service providers and patients to ensure best outcomes.  If an individual is receiving mental health services, then the providers will share information about the patient’s current needs in both physical and mental health.  If the individual is not referred to or does not seek out mental health services, then there is no mental health component to manage.

Meanwhile in Massachusetts, every pediatrician is mandated to offer CANS (Child and Adolescent Needs and Strengths), a lengthy evaluation form that asks a patient (aged 5 to 20 for the link above) to evaluate their own life and mental health on sets of 0-3 scales.  CANS is used to monitor children’s mental wellbeing and identify potential problematic areas, including whether a mental health referral for serious emotional disturbance is necessary.  To the best of my knowledge, this information is not stored and used as an indicator for managed care, as blood pressure and weight are.

What if this type of information was collected yearly from every person and used to coordinate service provision?  What if incentives were used so that care coordinators received more money for improving the mental health of their clients, not for providing less services?  Squeamishness about more readily available personal information aside, the positive impact on our lives could be enormous.  If competition and well placed incentives does truly foster efficiency and innovation, directly making people happier would be the most exciting area for this to take place.

One could imagine mental health care coordinators noticing developing social problems and providing therapy to resolve issues as they come up.  Care coordinators could see growing isolation and encourage participation in activities that a client might enjoy.  Care coordinators could arrange for tutoring or peer mentorship if a client appears to be underachieving.  In the end, the use of a mental health indicator in managed care could help create a more concerned and caring world, and make patients happier as well as healthier.


Nathaniel Counts was a Student Fellow during the 2013-2014 academic year. At the time, he was in his third year at Harvard Law School. He was interested in the role of law and lawyers in the treatment of mental health issues, with a focus on behavioral disorders, including intersections with the criminal justice system. He was also interested in the use of a right to health care in human rights lawyering and international development. Nathaniel graduated from Johns Hopkins with a major in biology and a minor in entrepreneurship and management. Prior to law school, he studied creative writing at Bar-Ilan University in Israel. His past research focused on the federal government’s response to marijuana legalization, including recommendations for public health initiatives; he published an article on this subject in the Gonzaga Law Review in 2014.

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