Seen and not heard: planning for children's mental health in managed care

This article reviews the tension between "gatekeeping," routinely practiced by managed care to limit utilization of care and, presumably, cost, and the increased demands of purchasers (such as Medicaid), consumer groups, and the National Council for Quality Assurance for mental health screening, outreach, and access to specialty care, particularly for vulnerable populations. Using examples from Harvard Pilgrim Health Care in Boston, the second oldest health maintenance organization in the country, the argument is advanced that early detection, coordination with primary care, and readily available expert consultation actually diminish cost while reducing morbidity and improving satisfaction.