The State of Maryland and Montgomery County, Md., are not the only state and county that have shifted the delivery of public mental health funds and services to a managed care-privatized system.

Thirty-one states now have managed care Medicaid plans for at least some individuals in the public mental health system, according to a report published in May by the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C.

Whereas a number of states have had considerable success in this area, others have not, the report stated. Massachusetts is one state that has done very well, Gail Toff Bergman of the Lewin Group in Falls Church, Va., said in an interview. The Lewin Group has been contracted by the federal government to monitor behavioral health care in the 50 states. In contrast, Tennessee is a state that has done poorly, she pointed out. To date, three states have decided to stop using managed care for their public mental health systems, she added. They are Arkansas, Montana, and North Carolina.

Some of the positive effects of managed care on public mental health delivery, according to the report, are increased access to care, decreased use of inappropriate inpatient care, and an expanded array of services. Some of the negatives are an incentive to undertreat, particularly those with serious disorders; to focus too much on acute care and not enough on rehabilitation and other services that could have significant long-term payoffs; and to have trouble serving the non-Medicaid population.

As for the privatization of public mental health clinics, about one-third of the counties in the United States have done it, Lauren Wolf of the County Behavioral Health Institute in Washington, D.C., told Psychiatric News. These include San Diego County in California, three counties in Washington state, and many counties in Pennsylvania, Toff Bergman said.

How successful has the privatization of public mental health services been in counties? No one knows for sure, Wolf replied, since a national study of such privatization has not yet been conducted.