Taking the Battle Against Managed Care to the Net 

Michaele P. Dunlap, Psy.D.
An expanded version of this article was published in The Independent Practitioner, October, 2000.  It is reproduced here with permission of Psychologists in Independent Practice, a Division of the American Psychological Association and the author

I believe strongly that the managed care experiment has indeed already failed, and that the system continues to grow partly out of inertia, and partly because it is, overall, so cash-rich that it doesn't know that the end is in sight. (Let me add, however, that we must continue to help insure its demise.) Peter Gumpert, Ph.D, Founder of The American Mental Health Alliance, in a speech given to the National Mental Health Foundation, Spring, 1998.

Mental health professionals of compassion and integrity protest against managed care. Sometimes they take to the streets to protest as they did on April Fools Day, 2000. See:<http://wwwRescueHealthCareDay.com>. They have cried out against the fact that managed care profit seeking has dismantled public and private social and human services and mental health agencies that were painstakingly created over decades (Schamess, 1998). Many have protested managed care invasions of privacy and the forced shift from clinical process and relationship toward brief, fragmented therapeutic procedures (Munson,1998). But managed care protesters have usually cried out unheard. Cash-rich managed care corporations continue to sway political action and to promote the lies that they create "savings" and "assure quality." Until those who oppose manage care find a place to stand together and be heard, the power of managed care to hurt and kill (Court & Smith, 1999) will continue.

Managed care systems devalue the people who give care to patients. Dealing with managed care creates a "surplus powerlessness" (Lerner, 1986) that can corrupt, change and distort us as professionals. This surplus powerlessness has led mental health practitioners to accept the diminishing fees and invasive demands of managed care companies as if they were inevitable. In a strange way we should be grateful to the managed health care industry. The blatant greed and hypocrisy has been very clear for some time now, and we can no longer have any excuse for inaction.

Some enterprising and self-assured psychologists and mental health therapists have broken away from managed care and created private pay, private service practices, (Ackley, 1997) or have begun to collaborate together in Guilds (Miller, 2000) in order to inform the public of the advantages of paying out of pocket for psychological services.

The American Mental Health Alliance (AMHA-USA) is five years old. It began as a cooperative organization of mental health professionals in Massachusetts, designed to offer full service mental health and substance abuse care contracts to employers in direct economic competition with managed care companies. AMHA chapters formed in several states focused on this contracting objective. AMHA is "the finest example of a not-for-profit, practitioner-directed interdisciplinary network of mental health professionals" (Zadikow, 1998). Yet, after four years work to create visibility, market contracts and build membership participation it became clear to AMHA-USA’s grass roots organizers that the objectives of AMHA-USA must become more comprehensive and more focused.

In a series of national meetings AMHA-USA’s objectives and focus were refined:

The Mission of the American Mental Health Alliance-USA is to support and market competent, ethical mental health services that preserve privacy and confidentiality.

AMHA-USA supports these Principles:

that an individual has the right to choose his or her own therapist;

that the client and therapist shall determine the course of therapy;

that therapists shall preserve client confidentiality;

that reimbursement methods should support ethical practice;

that mental health professionals should practice in an interdisciplinary community which promotes competent and ethical practice.

AMHA-USA has taken its basic premise of professional collaboration a giant step further, creating and launching a web site, <http://www.AmericanMentalHealth.com>, that will market the services of competent, ethical professionals to the public including psychotherapy, assessment, business and agency consultation, training, supervision and education. The web site will offer consumer information and networking and consultation opportunities for professionals.

Expanding the principled mission of AMHA-USA on the Internet at AmericanMentalHealth.com offers a vehicle to speak together about the skills we offer and the value of our professional services. Participation in AmericanMentalHealth.com and the American Mental Health Alliance is open to every independent mental health professional in the United States. The demise of managed care can be hastened, and you can participate.

With the collaboration and cooperation of thousands of mental health professionals, AmericanMentalHealth.com will become a "virtual community" -- linking peers, providing mental health information to the public, marketing ethical services, and supporting the development of AMHA State chapter activities.

Why the Internet?

The Internet is the great equalizer. On the Internet AMHA’s mission and its client-focused principles can be seen by a public that is rapidly growing wary of the false promises of managed care. The capabilities of independent practitioners can be visible.

The web site <http://www.OregonCounseling.Org> developed by AMHA-Oregon member, Michael Conner, Psy.D., sponsored by Mentor Research Institute, demonstrates the value of providing information and AMHA-member therapist resources to the public. That site offers a model for consumer information and protection materials to be created for all states.

Development of AmericanMentalHealth.com began in February 2000. The site is designed to allow administration by each AMHA chapter and permit each AMHA member personal control of a web listing or web page information. The site is database driven with capacity to accommodate programs of all existing and future AMHA state chapters. The site has audio capacity for educational and marketing messages. Its e-commerce capability can support the process of marketing and financial management for AMHA’s ethical contracts.

AmericanMentalHealth.com articles will educate the public about the value of caring professional interventions versus the arbitrary limits and mandated medications of managed care. AmericanMentalHealth.com will inform people about a vast array of mental health topics while simultaneously serving to organize and present the skills of members. A potential client will search for a therapist on key words related to location, or to the kind of services sought: i.e. "marriage counseling," "business consulting;" or related to the person i.e. "child," or "handicapped" or "Spanish speaking;" or key words related to a theory, technique, or mode of service: i.e. "Jungian," "EMDR," or "home visits." There will be capability for printing member directories for AMHA Guilds, for contracts, and for specialized marketing activities.

Participation in AmericanMentalHealth.com and the American Mental Health Alliance is open to every qualified mental health professional in the United States.

AMHA-USA intends to:

organize chapters in all fifty states, according to the laws of each state that regulate the marketing efforts of mental health professionals.

operate a nationwide referral service and information resource for consumers on the website: <http://www.AmericanMentalHealth.com>

support the development of self-pay fee-for-service marketing efforts such as Psychotherapists’ Guilds (which offer fee reductions for payment at the time of service with no paperwork) and other direct to the public mental health marketing collaborations.

support the development of discount fee-for-service plans (also called Affordable Care Plans) marketed to groups.

support the development of ethical contract relationships with groups for the provision of mental health and substance abuse treatment services.

create contracts between state chapters of this self-managing Alliance and groups to whom they provide services without the participation of costly and intrusive outside parties whose interests may conflict with the ethical and professional responsibilities of our various mental health disciplines.

respect and preserve the professional integrity of its members, and the confidentiality of client-therapist relationships.

develop and continually improve programs for delivery of high quality mental and behavioral health services, including substance abuse services.

Features available at AmericanMentalHealth.com:

1. Practice listings that are "searchable" for member professionals, with data entry and management by the member.

2. Enhanced web pages, which include the data base searchable listing, links to personal web sites, professional photos and other features that enhance marketing for clinical practice, books, products, training events and workshops. The member will manage his/her own page.

3. Articles submitted by members will be searchable for the Internet; displayed on the site and linked to members’ practice information. (A marketing loop that will direct potential clients to the writer.) If a member wants to record an audio of why his/her practice is specially suited to some particular issue, he or she can post the file on the "Audio" page with a link to their enhanced listing information. If a member wishes to sell a book at the site they are featured at the "Books" page.

Where there is a state chapter, new AMHA members join that chapter and have the advantage of established marketing and peer consultation programs. Where there is no state AMHA chapter, members will join "provisionally." When the members in a state are ready to organize, AMHA-USA will support the process of a creating a State Chapter.

Participation in AmericanMentalHealth.com is open to "affiliate membership" of mental health researchers, academics and retired clinicians. Affiliate members may market books, products, training , etc. on AmericanMentalHealth.com.

Associate membership is open to students, interns and residents who plan to join AMHA chapters when they are licensed. Associate members’ names are linked to the practice listing of their supervisor who is an AMHA member.

Organizations and businesses - clinics, professional publishers, training organizations and treatment facilities – are welcome to affiliate with AmericanMentalHealth.com. The premise for affiliation is that the organization or business offer valuable services or products to the public or mental health professionals and is supportive of AMHA principals. Business and organizational affiliates can market services, publications and events on AmericanMentalHealth.com.


AMHA-USA is rich in principles and purpose. The ability of professionals to compete against managed care is based in our capacity to provide better services and more economically rational and caring contracts. The money, energy and expertise to create AmericanMentalHealth.com come from dedicated mental health professionals who believe that collaborative efforts will result in the demise of managed care. Together competent professionals can re-create mental health services that were destroyed by managed care’s invasion. Managed care has sneered at our professional practices, calling us a "cottage industry." AmericanMentalHealth.com will link our "cottages" with Internet technology. Together we will market competent, ethical services and re-take the field for mental health.


Ackley, D. C. (1997). Breaking Free of Managed Care: A step-by-step guide to regaining control of your practice. New York: Guilford.

Court, J. & Smith, F. (1999) Making a Killing, HMO’s and the Threat to Your Health. Monroe, ME: Common Courage Press.

Gumpert, P. (1998.) "AMHA - Operating Principles and Current State"A speech given to the National Mental Health Foundation, Spring. A complete text of this speech is available on the web site: <http:// www.AmericanMentalHealth.com>

Lerner, M. (1986). Surplus Powerlessness: The Psychodynamics of Everyday Life and the Psychology of Individual and Social Transformation. Oakland, CA: The Institute for labor and Mental Health.

Miller, I. (2000). The Death of Solo Practice Has Been Greatly Exaggerated and How Guilds Can Help. Independent Practitioner, 20(3), 180-181.

Munson, C. (1996). Autonomy and managed care in clinical social work practice. Smith College Studies in Social Work, 66, 241-265.

Schamess, G. (1996). Who profits and who benefits from managed mental health care: Smith College Studies in Social Work, 66, 209-220.

Zadikow, C. (1998). An Alternative Mental Health Care Delivery System. The Coalition Report September, p. 6. Comack, NY: The National Coalition of Mental Health Professionals and Consumers.

Michaele P. Dunlap, Psy.D. is a past President of AMHA-Oregon and a Board Member of the National Coalition of Mental Health Professionals and Consumers. She is in private group practice in Portland, Oregon at Mentor Professional Corporation.

Michaele P. Dunlap, Psy.D.
Mentor Professional Corporation
818 NW 17th Ave.
Portland, OR 97209