Let’s start this post by harkening back to the dawn of the managed medical care era, just after Medicare and Medicaid programs were about to initially cry insolvency amid a new Nixon administration ready to try anything to put those social programs out of their misery. Back then, the words “doctor” and “trust” were interchangable entities among patients who could come to appreciate their care and expect a (reasonably) long and healthy relationship.

Fast forward a good forty years, and those government programs are still churning, albeit with major financial baggage gumming up the works; and patients no longer expect primary care with a singular provider from cradle to grave. As a Broken Health Care Nation, patients as consumers have come to expect nothing less.

But can the same thing be said about primary mental healthcare? What is probably seen as a boundary-busting dysfunctionally enabling relationship among client and provider by anonymous bean counting third parties is a closely guarded dyad steeped in trust and sanctimony by those same patients and their committed mental health treatment team.

It’s precisely this issue of trust which is at the center of the fight between a District of Columbia’s city council decision to close publicly funded mental healthcare clinics in favor of private contracts for those patients whose trust in that care delivery model is solid. To say that they have to deal with the alternative is laughable, and they came out in full force to protest the proposed action. | LINK

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