HMOs and the seriously mentally ill--a view from the trenches.

The role of HMOs in health care policy, specifically in treating individuals with long-term persistent illness, is a matter of debate. The following is a response to a summary of the research to date entitled "Health Maintenance Organizations and Persons with Severe Mental Illness" previously published in this journal. The author argues that capitated pre-paid payment mechanisms can and should be considered separately from the decision of funding an HMO or other managed care structure. The argument is made that, with proper planning, the existing community mental health system can make capitated payment system changes, while avoiding dual health and social services systems. Savings in the expenses of dual systems and maintenance of the charitable missions with local oversight of CMHC can result.