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Differences in the Use of Psychiatric Outpatient Services between the United States and Ontario
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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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“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
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Metadata
- 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)
- 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
- 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
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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