Changing Profiles of Service Sectors Used for Mental Health Care in the United States

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Abstract
Objective: Redesigning the fragmented U.S. mental health care system requires knowing how service sectors share responsibility for individuals’ mental health needs. Method: 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.