Using econometric and descriptive statistical methods, correlates of the distribution of psychiatrists, psychologists, and social workers across United States counties are presented. The majority of counties have either none or very few of the three mental health provider groups considered. The distribution of all three groups is significantly and positively associated with the number of providers at a previous time period, the availability of liberal mental health insurance benefits, the percentage of the population with some college education, the percentage of the population between ages 20 and 64, the density of primary care physicians, and other variables. Causal distributional hypotheses and related public policies are considered.

The bulk of questions pertained to the last five consecutive patients seen in or terminated from individual treatment. The collected data serve as a basis to generate hypotheses about professional behaviors within the confines of the mental health services provision system. Among the major hypotheses developed are the following." (a) Patients with less severe mental and emotional conditions dominate the case mix of each provider group; (b) the psychiatrist's case mix has the highest percentage of the more severe conditions, and the primary care physician's has the highest percentage of alcoholism and substance abuse," (c) condition severity and financial attributes are major determinants of the patient's entry into, interaction with, and progress through the services provision system; (d) there is a weak negative linear relationship between intensity of services and initial severity," (e) regardless of provider group, the majority of patients complete a treatment episode in relatively few visits and leave treatment with little noticeable impairment; (f ) patients with more severe conditions are more impaired at treatment termination than are patients with less severe conditions; (g) providers and practice settings differ according to the number of patients, but not the severity of condition, within a particular patient condition category," and (h) provider substitution is most possible for patients with less severe conditions or when care is provided in organized, multidisciplinary practice settings. Hypotheses concerning condition severity and provider substitution suggest tentative ideas regarding the roles of the mental health services providers surveyed and the organization of the services provision system.

A national sample (N = 581) of psychiatrists, clinical psychologists, and social workers responded to questionnaires presenting four case vignettes taken almost verbatim from the American Psychiatric Association's DSM-llI Case Book. Each vignette was prepared in order to ensure that all available information relevant to making diagnoses was included; however, the diagnoses were not presented to the respondent. Respondents wrote their statement of the presenting problem and its severity and selected the best treatment plan and referral and the experts' diagnosis from lists of alternatives. Results suggest that as diagnosticians, these provider groups are essentially equivalent but that diagnostic findings are more reliable for the more severe mental disorders. Providers appear to alter their treatment plans depending on diagnosis, but for a particular diagnosis, they differ little as to the interventions deserving emphasis. Each provider group refers to itself the patients with less severe mental and emotional conditions.The purposes of sorting the mental disorders into discreet categories are to aid communication about and understanding of clinical features, etiology, course, and treatment. Diagnoses are also now used for prospective reimbursement (Taube, Lee, & Forthofer, 1984). Because these uses are so important, the diagnosis of mental conditions has been DAVID J. KNESPER, MD, is an associate professor of psychiatry and assistant research scientist at the University of Michigan, where he is also chief of the Psychiatric Emergency Program. As a research psychiatrist, he is actively engaged in mental health services research that now concerns provider competition and services pricing. DAVID J. PAGNUCCO, BS, is a project manager at the Mental Health Research Institute (MHRI), University of Michigan. He has been involved with the design, management, and data analysis phases of several national survey projects at the Institute for Social Research, University of Michigan, and currently at the MHRI. Mr. Pagnucco's current research interests concern studies of mental health and primary care medicine and survey methodology. NEIL M. KALTER, PhD, received his doctorate in psychology from the University of Michigan in 1971. He is currently Associate Professor in the Departments of Psychology and Psychiatry at the University of Michigan. Dr. Kalter conducts courses in research design, statistics, child psychopathology, and prevention program development for psychology graduate students, and supervises child clinical work of trainees in psychiatry. He serves on the Editorial Board of the American Journal of Orthopsychiatry.

Studied the responses of 173 psychologists to a questionnaire requiring disaggregated data describing their last 2 patients. Ss were asked to recall patient data from memory and then to tabulate and record the actual data from their patients' files. Results indicate that the average perceived accuracy of the Ss' patient records was 4.6 on a scale of 1 (very inaccurate) to 5 (extremely accurate). (10 ref)

No abstract