Mental-Health Care of Military Dependents Assailed

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Military dependents--many of them children and adolescents--who have received mental-health care covered under Defense Department insurance have in many cases received poor or inappropriate treatment, a federal investigator told a Congressional committee last week.

A review of more than 500 cases handled by psychiatric hospitals, residential centers, and outpatient settings disclosed that one-third of the admissions were either clearly medically unnecessary or not substantiated, said David P. Baine, director of federal health-care-delivery issues for the General Accounting Office, in testimony before the House Select Committee on Children, Youth and Families.

The review, conducted by Health Management Strategies International for the Defense Department, also found that two-thirds of the cases did not meet "critical quality-of-care criteria'' or provided insufficient information to assess whether they met the criteria--such as having safety plans for those patients considered a risk to themselves or others.

In 1991, inpatient mental-health care for children and adolescents made up nearly half, or $305 million, of the $631 million in mental-health costs to the Defense Department's Civilian Health and Medical Program of the Uniformed Services.

While Mr. Baine said the Defense Department's management of health care has improved recently, he added that G.A.O. officials "continue to have substantial concerns'' about the mental-health care provided to Defense Department beneficiaries, "and believe that D.O.D. needs to take more aggressive actions to deal with problem providers.''

At the same hearing, other witnesses detailed similar care and private-insurance abuses, including private hospitals paying school counselors for referring students.

Private psychiatric hospitals and in-treatment centers place juveniles in residential programs when there is no need to do so, physically restrain and drug them for behavior problems, use up insurance benefits, and then turn children away as soon as the benefits are exhausted, said Curtis L. Decker, executive director of the National Association of Protection and Advocacy Systems, a nonprofit group that represents advocates for the mentally and physically disabled.

Mr. Decker also told of an "unethical'' marketing attempt by a hospital chain in Nevada, in which advertisements were placed in the state's largest newspapers on or near the days report cards were issued in school, targeting parents who were alarmed by their children's grades.

Vol. 11, Issue 33

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