National Trends in the Use of Outpatient Psychotherapy

Abstract

From 1987 to 1997, access to psychotherapy in the United States remained constant overall but was characterized by increased use by some socioeconomically disadvantaged groups. However, the number of visits per user markedly decreased during this period. Psychotherapy was increasingly administered by physicians and provided in conjunction with psychotropic medications. These changes occurred during a period of expansion in the number of available psychotropic medications and growth in managed behavioral health care.

School Mental Health Services: Signpost for Out-of-School Service Utilization in Adolescents with Mental Disorders? A Nationally Representative United States Cohort

“…Several studies have confirmed the prominent position of the medical specialty sector in providing services for mental disorders [41], even though the mental health specialty sector has been reported to be the major service sector for children and adolescents with mental disorders [13] and the most common subsequent service sector in adolescents entering the service system through the school mental health sector [18]. While mental health care in the medical specialty sector has improved over the past decade through a better understanding of mental disorders, the availability of practicable screening tools, provision of psychotherapy in these settings, and further development and promotion of psychotropic medications that are mostly prescribed by primary care physicians [24,42,43,44], most primary care pediatricians and child and adolescent psychiatrists believe that pediatricians should identify and refer, but not treat, their patients' mental health problems [45]. Indeed, the appropriateness of treatment of mental disorders in the medical specialty sector as compared to the mental specialty sector remains a matter of debate [46,47,48,49,50], which should be kept in mind when evaluating the referral patterns observed in the present study.…”

Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial

“…Worldwide, such initiatives are rare and more investment is needed. In the United States, less than a quarter of those with depression have seen a psychologist or counsellor in the previous 12 months 37 , and half receive less than the recommended number of therapy sessions 38 . Even those who attend therapy often receive an "eclectic mix of psychotherapy techniques" 39 rather than CBT.…”

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

“…Development and heavy promotion of new antidepressants and other psychotropic medications with improved safety profiles have further spurred care of mental disorders exclusively in general medical settings (8,9). There has also been a growing tendency for some primary care physicians to deliver psychotherapies themselves (33).…”

“…The NCS and NCS-R asked identical questions to assess age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54), sex, race-ethnicity (Non-Hispanic White, Non-Hispanic Black, Hispanic, other), marital status (married or cohabiting, previously married, never married), education (0-11, 12, 13-15, 16+), household income, and urbanicity. Income was defined as a multiple of the federal poverty line acounting for the composition of the respondent's family, with low income defined as an income: poverty ratio less than 1.5:1, low-average a ratio in the range 1.5:1 to less than 3:1, high-average a ratio in the range 3:1 to less than 6:1, and high a ratio of 6:1 or greater.…”