Health maintenance organizations and persons with severe mental illness

Many if not most scenarios for reform of the U.S. health care system imply that health maintenance organizations (HMOs) will continue their rapid growth. Some advocates argue that a comprehensive health care system should offer services to the severely mentally ill on the same basis as the physically ill. Others note that severe mental illness has traditionally been addressed by a separate, social service system which, for all its deficiencies, has at least provided some level of care. Still others contend that allowing severely mentally ill persons barrier free access to health care would be prohibitively expensive. Inspired by this debate the author reviews our knowledge about HMOs and persons with severe mental illness. It is argued that workers in community mental health programs need to understand HMOs and their potential contribution to providing services for persons with severe mental illness.Supported in part by NIMH grant number R01 MH45015. A reviewer's thoughtful comments are gratefully acknowledged.