History of managed behavioral health care and speculations about its future.

Abstract

Editor's Note For better or for worse, managed behavioral health care will likely be regarded as the most potent force affecting public health policy in psychiatry during the last quarter of the twentieth century. It is therefore odd that the history of its development has been given so little attention. This is probably because managed behavioral health care is so controversial that those who are affected by it are busy responding to its challenges rather than pondering its origins. The following article, by Kenneth A. Kessler, MD, is a noteworthy contribution to the record. As the first-hand account of an important participant in the events described, the paper is a useful reminder of the historical antecedents of what is often experienced as if it were the proverbial plague of locusts, unrelated to anything human. In the future, Dr. Kessler's account will be helpful to historians as they sort out the implications of the managed-care revolution from a broader perspective, enriched by the wisdom of hindsight.