Psychiatric Services Used More by the Less Severely Ill

Although psychiatric outpatient services are utilized more in the U.S. than in Ontario, Canada, most of these services are used by people with less severe mental illness.

Harvard investigator, Dr. Ronald C. Kessler and a multicenter team compared two population-based surveys on the use of psychiatric services conducted in the U.S. and in Ontario, to clarify the influence of health insurance on utilization. They found that both psychiatric disorders and outpatient treatment for psychiatric disorders are significantly more common in the U.S. compared with Ontario. However, "...the higher probability of use of services in the United States is confined to those with low levels of need for services."

Dr. Kessler suggests that the difference in the utilization of these services between the two countries can be explained by a "...higher probability of perceived need for treatment among U.S. residents with less severe illness." Further, he says, "...the match between some measures of need and treatment is not as strong in the United States," indicating that the overutilization of services by those with less need is counterbalanced by an underutilization among those with more severe need.

In a related editorial, Dr. Robert Michels of Cornell University in New York points out that "...just as our psychiatric treatments are growing more effective, we are contemplating changes in our health care system that may dilute access to psychiatric care even further." He notes that many of the mentally ill are poor and uninsured, and others simply don't seek medical care, and concludes that "...a market-based delivery system simply does not work for many severely mentally ill people."

>From the N Engl J Med 1997;336:551-557,578-579.