Behavioral Healthcare Tomorrow magazine

LEFT BEHIND: The Seriously Mentally Ill in the Managed Care Era
An Interview with E. Fuller Torrey, M.D., and Dan Fisher, M.D., Ph.D

By Robin Dorman (

Has the managed care system failed the most afflicted? Two medical mavens who have gained national attention for their outspoken and revolutionary views see vast room for improvement. But E. Fuller Torrey, M.D., and Dan Fisher, M.D., Ph.D., do not necesarily agree on a solution. Torrey, executive director of the Stanley Foundation research programs and president of the Treatment Advocacy Center (TAC), is an ardent supporter of increased funding to treat mental illness and favors involuntary commitment for seriously ill persons who do not seek services.Within the ranks of the National Alliance for the Mentally Ill, which no longer has a governance relationship with TAC, there has been in response to Torrey’s view the full roar of dissent. Fisher, who was diagnosed with schizophrenia and is now executive director of the Lawrence, Mass.-based National Empowerment Center, opposes involuntary treatment and wants mental health resources diverted to recovery-oriented strategies for consumers.

BHT: Managed care plans often cover treatment for schizophrenia under state contracts, but not under employer contracts. Is it appropriate for employers to exclude coverage for schizophrenia from their benefit plans?

TORREY: It is completely inappropriate and absurd for any contract to cover some brain diseases but not others. Any contract that covers Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, strokes, etc., should by definition also include schizophrenia, manic-depressive illness, and severe depression. I think there are two reasons why this is happening. Until recently, there has been little understanding that severe psychiatric disorders are brain diseases. The people who are making the decisions regarding coverage are often behind in their understanding of these research areas. Secondly, most insurance companies and managed care plans, especially those that are for-profit, want to cover as little as possible so they can make more money. So they are not keen to add new diseases unless they have to.

FISHER: I wasn’t aware that they excluded it. My hunch is that they may be because they say it’s not curable. I certainly feel it is a condition people can recover from, but often they need help in the recovery process, whether it be therapy, peer support, even occasionally medication. I certainly think schizophrenia should not be excluded. I personally was diagnosed with schizophrenia and feel that the therapy I received was helpful in my recovery process because I believe there is meaning to the symptoms I was going through based in my life experiences, and I had to understand more about my life experience to recover. I might add that I would emphasize voluntary treatment over involuntary, an outpatient, community-based approach over institutional care.