Changing profiles of service sectors used for mental health care in the United States.
OBJECTIVE
Redesigning the fragmented U.S. mental health care system requires knowing how service sectors share responsibility for individuals' mental health needs.


METHODS
Twelve-month DSM-IV mental disorders and their severity were assessed in respondents ages 15-54 from the National Comorbidity Survey (NCS) in 1990-1992 (N=5,388) and the NCS Replication in 2001-2003 (N=4,319). Six profiles involving potentially multiple service sectors were defined, including those in which pharmacotherapy plus psychotherapy (psychiatry profile, general medical with other mental health specialty profile), single modalities (general medical only profile, other mental health specialty only profile), or neither modality (human services only profile, complementary/alternative medicine only profile) could potentially have been received. The use of profiles was compared between surveys.


RESULTS
The general medical only profile experienced the largest proportional increase (153%) between surveys and is now the most common profile. The psychiatry profile also increased (29%), as did the general medical with other mental health specialty profile (72%). The other mental health specialty only (-73%), the complementary/alternative medicine only (-132%), and the human services only (-137%) profiles all decreased in use. The elderly, women, minorities, the less educated, and rural dwellers were less likely to use profiles capable of delivering pharmacotherapies and/or psychotherapies.


CONCLUSIONS
How service sectors share responsibility for peoples' mental health care is changing, with more care falling to general medical providers rather than specialists. Efforts are required to ensure that people who would benefit have access to the necessary treatment modalities.
Wang
Philip S
PS
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave., Boston, MA 02115, USA. wang@hcp.med.harvard.edu
Demler
Olga
O
Olfson
Mark
M
Pincus
Harold A
HA
Wells
Kenneth B
KB
Kessler
Ronald C
RC
D000293:Adolescent; D000328:Adult; D000529:Complementary Therapies / Q000706:statistics & numerical data / Q000639:trends; D003695:Delivery of Health Care / Q000639:trends*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005194:Family Practice / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data* / Q000639:trends; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000706:statistics & numerical data / Q000639:trends; D013038:Specialization; D014481:United States / Q000453:epidemiology