Montana psychiatrist Noel Drury, M.D., spent two years organizing a statewide protest against a huge managed care company whose failure to pay reimbursements on time caused havoc in the state’s mental health facilities. At its meeting last month in Washington, D.C., the APA Assembly showed its appreciation for his efforts by presenting Drury with its 1999 Profile of Courage Award.

Because of a corporate merger, Magellan Behavioral Health, one of the country’s largest mental health care carveout companies, had inherited the contract to manage the mental health care of 20,000 Medicaid recipients and 5,000 others in Montana with serious psychiatric illnesses. From the time it took over the contract, however, the company was chronically behind in reimbursing practitioners and facilities within a reasonable amount of time as called for in its contract with the state.

In a sparsely populated state with few psychiatric facilities to serve a vast geographic area, Magellan’s failure to pay reimbursements on time led one major mental health facility, the Western Montana Mental Health Center in Kalispell, of which Drury is medical director, to the brink of shutting its doors. It also threatened to drive psychiatrists and other clinicians out of the state system.

Recognizing the looming crisis that was about to befall Montana citizens who needed mental illness treatment, Drury, with help from colleagues in the Montana Psychiatric Association, organized local advocacy groups of clinicians, administrators, and patients and their families who demanded that state lawmakers cancel Magellan’s Medicaid contract. He also wrote articles for local media alerting readers to the crisis and coordinated protest rallies at the state capital in Helena.

Drury’s labors paid off when in late March the state legislature voted in favor of terminating Magellan’s Medicaid contract, which was followed by an agreement between the company and Governor Marc Racicot to end the arrangement.

After the legislature called on Magellan to end its oversight of the state’s Medicaid mental health program, Drury then organized a joint initiative with APA’s Office of Health Care Systems and Financing. APA staff and consultants went to Montana to help develop an alternative system for providing mental health care to Medicaid recipients without the intervention of a managed care company. Drury and his colleagues are now working with Montana public health officials to craft a new system that provides mental health care to the state’s poor and seriously ill citizens.

In receiving the Assembly’s award, Drury said he was especially grateful "for all I have learned from my work with consumers and their families. Their courage and ability to withstand the slings and arrows of mental illness has inspired me."

He was spurred to action, he added, by the realization that "my desire to help with the anguish of my patients was being smothered by absurdist architecture of pseudo-finance and pseudo-planning. . . . My lifelong dream of caring for people was being systematically dismantled."