Robert L. DuPont

Abstract

The 1980s may prove to be the decade we rediscover the old adage “There is no such thing as a free lunch.” The fact that, as a nation, our “benefits” and “entitlements” cost us as individuals seems clearer with each passing day. It is hardly surprising that the dominant issue in the field of mental health is money—since that appears to be the dominant issue in most fields. More remarkable to me is the fact that during the past two decades mental health professionals have taken for granted that our services should be covered by health insurance. This has been true even as our definitions of our roles have expanded almost without limit during these years, and even as the category of “providers” (a revealing description of the dominance of the financial transaction involved in our services) has exploded. Now we find, to our discomfort, that the one who pays the piper is being more visibly seen to call the tune. Many of us do not like it. The first reaction for many psychiatrists has been to pull the medical cloak more snugly around us: Let’s save money by excluding the “nonmedical” providers. Next to go is “long-term intensive” psychiatric outpatient treatment. Will this process end with coverage for mental illness restricted to the physician prescribing psychotropic medications on “brief office visits” coupled with hospital-based inpatient care? Those, after all, are the final defensive positions.