In recent years, to reduce costs, the managed-care system has
encouraged primary-care doctors with no psychiatric training to treat
the more common mental-health problems. Physicians follow treatment
“protocols”-formulas dictating when to prescribe
medications-based on simple symptom checklists. Under pressure to
keep expenses down and meet service quotas, doctors have little time to
discuss a patient’s history or current circumstances. Glenmullen
points out in Prozac Backlash that the introduction of the SSRI
(selective serotonin reuptake inhibitor) antidepressants such as
Prozac, Paxil, and Zoloft, with ¨¬their one-size-fits-all-patients ease
of use and broad applicability for dozens of conditions,0Š6 has
facilitated the outsourcing of mental-health care: ¨¬[M]anaged-care
insurers,0Š6 he writes, ¨¬[have] pressed primary-care doctors to limit
the treatment of depression and psychiatric conditions to drugs with no
regard whatever for the long-term consequences for patients.0Š6

Ronald Kessler’s findings suggest that these policies undermine the
quality of care patients receive. The number of people seeking
mental-health treatment from general practitioners has increased by 150
percent in the past 10 years. In many cases, Kessler points out, the
physician didn’t complete the necessary clinical assessment, didn’t
prescribe the appropriate therapy, or failed to provide ongoing
monitoring. Based on these criteria, he asserts, only 12.7 percent of
patients receiving treatment in this sector obtained “an acceptable
standard of care.”