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Rationing Sanity
Ethical Issues in Managed Mental Health Care
James Lindemann Nelson, Editor
Georgetown University Press, 2003

Mental illness is the poor, and somehow "damaged," cousin to physical ailments in the eyes of too many in our society. Compare the difference in how people would respond to someone who had fallen and broken their leg on the street, to how most react to those mentally ill among us, on those same streets, who spend their winters on steam grates and forage for food in dumpsters. Rationing Sanity is a provocative analysis of the mental health care system in the United States, dealing with issues of justice and access to mental health care.

How should a decent society, affluent but facing many serious calls on its resources, best care for citizens afflicted with severe and persistent mental illnesses? James Lindemann Nelson brings together, for the first time, scholars of the ethics of mental health care and top managed care policy analysts to address this crucial problem. Rationing Sanity integrates those perspectives with the thoughtful practice-based experience of physicians well versed in the actual care of people with emotional and behavioral problems. Over a period of years, the contributors met face-to-face to engage each other on the ethics of managed mental health care—the result is a unique, collaborative effort that provides a wealth of important new insights on not only how Americans can readjust their attitudes toward the mentally ill—but also how we may find more just and humane treatment for those afflicted.

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front cover of The Real World Guide to Psychotherapy Practice
The Real World Guide to Psychotherapy Practice
Alex N. Sabo
Harvard University Press, 2000
“All of us who have long done this work can look back at those happy times when the patient’s gain has also been, in part, our own. Thereby an extraordinary joy enters the work, for both parties, through this making of lives. Can there be better work to do in the world?”—from the Epilogue by Leston HavensManaged care has radically reshaped health care in the United States, and private long-term psychotherapy is increasingly a thing of the past. The corporatization of mental health care often puts therapists in professional quandaries. How can they do the therapeutic work they were trained to do with clients whom they may barely know, whose care is intruded upon by managed care administrators? With unrelenting pressure to substitute medications for therapy and standardized behavior protocols for individualized approaches, what becomes of the therapist–client relationship?Unflinchingly honest, The Real World Guide to Psychotherapy Practice offers both compelling stories and practical advice on maintaining one’s therapeutic integrity in the managed care era. Resisting a one-size-fits-all approach, the authors focus on the principles of forming relationships with patients, and especially patients likely to be under-served (e.g., the uninsured poor) or difficult to treat.The Real World Guide to Psychotherapy Practice gives voice to therapists’ frustrations with the administrative constraints under which they work. But it accepts the reality and offers guidance and inspiration to committed therapists everywhere.
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