Income differences in persons seeking outpatient treatment for mental disorders - A comparison of the United States with Ontario and the Netherlands

Background: Variations in the relationships among income, use of mental hea lth services, and sector of care are examined by comparing data front 3 cou ntries that differ in the organization and financing of mental health servi ces. Methods: Data come from the 1990-1992 National Comorbidity Survey (n=5384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6 321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental healt h services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sec tors: the general medical sector, the specialty sector, and the human servi ces sector. Results: No significant association between income and probability of any m ental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences amon g countries in the association between income and sector of mental health c are treatment. In the United States, income is positively related to treatm ent being received in the specialty sector and negatively related to treatm ent being received in the human services sector. In the Netherlands, patien ts in the middle income bracket Lire less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the h uman service sector. Income is unrelated to the sector of care for patients in Ontario. Conclusions: Future research should examine whether differential access to the specialty sector for low-income people in the United States is associat ed with worse mental health outcomes.