Hi XXXXXXX

Over the years, psychiatric treatment has undergoing significant changes progressively. Of late a lot of new concepts have been introduced in treatment principles and concepts. Research has had a significant influence on both out-patient and in-patient treatments in the field of Psychiatry. Similarly, concepts such as ‘managed care’ have also brought changes to the way out-patient treatment is approached. Let us look at these individually...

In my opinion, research has positively influenced out-patient psychiatric treatment to a great extent. It is research which has given valuable insights into the understanding of psychiatric illnesses and helped find appropriate treatment strategies. This understanding into the cause and treatment of mental illness has changed the whole scenario of psychiatric treatment from a setting where persons with psychiatric problems were kept locked in asylums to a setting where most people are managed on an out-patient basis itself.

Research has also helped in the formulation of clear diagnostic and treatment guidelines, so that even general practitioners are able to diagnose and treat minor psychiatric problems on an out-patient basis itself. It has been found that, of late, the proportion of patients requiring in-patient treatment or long-term hospitalization has reduced drastically, thanks to the good out-patient treatment options and facilities currently available. This is all predominantly due to the influence and impact of research.

So, I feel that research has had a predominantly positive influence on psychiatric treatment, especially in the out-patient setting.

Coming to the other concept of “managed care”, this is a concept which has been recently introduced in many western countries, mainly pertaining to out-patient treatments. According to this concept, the main intention is to reduce the cost of for providing healthcare and improving quality. There are various techniques which encourage medical professionals to cut down costs, but at the same time, ensure that effective and quality care is being provided. Now, the influence of this concept of managed care in out-patient treatment has been variable. There are some clear positive influences, but at the same time there are a few negative aspects also.

One of the main positive influences is that it has enabled more financially effective ways of providing out-patient treatment. By cutting down unnecessary costs, the money saved can be channelized to cover more people, improve quality and expand the health system. Some of the impacts which this has had on out-patient practices are:
-     Avoiding unnecessary investigations.
-     Following strict protocols and avoiding unnecessary referrals
-     Bringing in more emphasis on preventive care
-     Quality checks to ensure good standards of practice.

However, some are critical about this concept and argue that it has influenced healthcare in a negative way. The arguments are:
-     Managed care plans were controlling costs by denying medically necessary services to patients
-     When the prime focus of a healthcare provider is on cutting costs, then quality gets compromised.

So, we see that such recent concepts have brought about both positive and negative influences on out-patient psychiatric care.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist.

---