How Do I Code for Black Fingernail Polish? Finding the Missing Adolescent in Managed Mental Health Care


  • Rebecca J. Lester


In this article, I examine clinical dilemmas in treating adolescents with eating disorders under the U.S. managed healthcare system. Managed care is built on a rational choice model of human behavior with little room for considering developmental processes. In this model, adolescents figure as little more than failed adults. This poses significant problems: if treatment providers prioritize developmental issues over quantifiable behavioral milestones, they risk jeopardizing continued coverage for their clients. If they prioritize quantifiable behavioral change without attending to underlying developmental concerns, they risk not affecting lasting change. Through a case study of a client in treatment for an eating disorder, I illustrate how this dilemma frames everyday encounters and negatively impacts client care, while at the same time missing developmentally meaningful opportunities for healing. An outline for a proposed applied psychiatric anthropology is presented, together with specific recommendations for adolescent mental health policy, research, and practice.