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Cited by 186Mental Health Treatment and AccessPsychiatric care and mental health servicesHealthcare Policy and Management

Differences in the Use of Psychiatric Outpatient Services between the United States and Ontario

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Kessler, Ronald C., Frank, Richard G., Edlund, Mark, Katz, Steven J., Lin, Elizabeth, Leaf, Philip·1997·New England Journal of Medicine
DOI 10.1056/nejm199702203360806
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Abstract

BACKGROUND: The relation between health insurance and the use of mental health services is unclear. We compared the use of outpatient services for psychiatric problems in the United States and Ontario, Canada, among young and middle-aged adults according to self-reports of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised) and to other indicators of need. METHODS: We analyzed two general-population surveys carried out separately in the United States and Ontario in 1990 that used identical assessments of need for services and questions about their use by persons 15 to 54 years of age. RESULTS: Respondents in the United States were significantly more likely than those in Ontario to report having had psychiatric disorders, poor mental health, or workdays lost or cut short because of psychiatric problems in the previous year. A significantly higher proportion of respondents in the United States (13.3 percent) than in Ontario (8.0 percent) had obtained outpatient treatment in the previous 12 months for psychiatric problems. However, an analysis of subgroups found that the higher probability of the use of services in the United States was confined to people with less severe mental illness. The average number of visits did not differ significantly between the two countries among patients who had similar numbers of psychiatric disorders over the same time periods. There was a stronger match in Ontario than in the United States between the use of services and the measures of perceived need we considered. CONCLUSIONS: Although the mental health care system in the United States provides treatment to a larger proportion of the population than that in Ontario, the match between some measures of need and treatment is not as strong in the United States. Any plans to expand coverage for psychiatric disorders in the United States must address this problem.

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  • Some evidence indicates cross-national differences in how SES relates to mental disorder treatment.

    “there is some evidence of cross-national differences in the association of SES with mental disorder treatment (Kessler et al. 1997; Van Doorslaer & Masseria, 2004; Devaux & De Looper, 2012).”

    From Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys (2018) · cites this paper as Kessler et al. 1997

    The paper’s introductory discussion (section labeled Abstract; page unavailable) contrasts access in Ontario and the United States and says people with limited financial resources face greater barriers in the United States. This supports a possible cross-national socioeconomic difference, but the reported analyses compare treatment by level of need, not the association between SES and treatment across countries. (LLM, conf=0.78)

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Research works printed but not linked: 1

  1. Macnaughton E. Towards rebalancing Canada's mental health system. In: Community investment. Vol. 2. Toronto: Canadian Mental Health As- sociation, 1991.

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Related

Authors
Kessler, R. C., Frank, R. G., Edlund, M., Katz, S. J., Lin, E., & Leaf, P.
Affiliations
  • Harvard University (US)
  • University of Michigan (US)
  • Johns Hopkins University (US)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1997-02-20
Volume
336
Issue
8
Pages
551-557
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199702203360806
OpenAlex
W2067766571
Cited by
185
References
25
Citations by year
2024: 1 · 2023: 1 · 2022: 3 · 2020: 2 · 2019: 1 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 1 · 2014: 4 · 2013: 6 · 2012: 5
FWCI
24.86
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • TSpace (University of Toronto) (submittedVersion)
Funders
  • National Institutes of Health (5r01mh052861-04)
  • National Institute of Mental Health (MH52861, MH-49098, MH46379, R01MH049098)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
psychiatric outpatient services, mental health service utilization, health insurance coverage, mental illness severity, perceived need for mental health care, cross-national comparison, United States, Ontario, young and middle-aged adults, access to mental health care
MeSH terms
Adolescent, Adult, Ambulatory Care, Mental Disorders, Health Services Accessibility, Health Services Needs and Demand, Humans, Mental Health Services, Middle Aged, Ontario, United States, Health Care Surveys

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