MENTAL-HEALTH TREATMENT IN ONTARIO - SELECTED COMPARISONS BETWEEN THEPRIMARY-CARE AND SPECIALTY SECTORS

Objective: Epidemiologic research has demonstrated that the majority o f mental illness in the community is not treated. Primary care physici ans and the specialty mental health sector each have an important role in the provision of mental health services. Our goal is to clarify th e extent of undertreatment of selected mental illnesses in Ontario and to examine how treatment is divided between the primary care and spec ialty sectors. In particular, we are interested in both the relative n umbers and the types-based on sociodemographic and severity indicators -of patients found in each sector, as well as in confirming the key ro le of primary care in the provision of mental health services. Method: Data were taken from the Mental Health Supplement to the Ontario Heal th Survey, a community survey of 9953 individuals. All subjects who me t DSM-III-R criteria for a past year diagnosis of mood, anxiety, subst ance abuse, bulimic, or antisocial personality disorders were categori zed by their use of mental health services in the preceding year-into nonusers, primary care only patients, specialty only patients, and bot h sector patients. The 3 groups utilizing services were then compared by demographic, clinical, and disability characteristics. Results: Onl y 20.8% of subjects with a psychiatric diagnosis reported use of menta l health services, but 82.9% of these same individuals used primary ca re physicians for general health problems. Among those who used mental health services 38.2% used family physicians only for psychiatric tre atment compared with 35.8% who used only specialty mental health provi ders, and 26.0% who used both sectors. The 3 groups of users showed on ly modest differences on sociodemographic characteristics. Patients in the specialty only sector reported significantly higher rates of sexu al and physical abuse. On specific disability measures, all 3 groups w ere similar. Conclusion: The vast majority of individuals with an untr eated psychiatric disorder are using the primary care sector for gener al health treatment allowing an opportunity for identification and int ervention. Primary care physicians also treat the majority of those se eking mental health services, and individuals seen only by these prima ry care physicians are probably as ill as those seen exclusively in th e specialty mental health sector. From a public health perspective, fu ture policy interventions should aim to improve collaboration between the 2 sectors and enhance the ability of primary care physicians to de liver psychiatric services.