Mental health service use by Americans with severe mental illnesses

Background: The aim of this study was to determine the patterns and determi nants of service use in severely mentally ill persons drawn from the Nation al Institute of Mental Health Epidemiological Catchment Area (ECA) program, a community-based epidemiologic survey. This information provides a baseli ne against which to track ongoing changes in the US mental health service s ystem. Methods: Severe mental illness (SMI) was defined according to US Sen ate Appropriations Committee guidelines. Comparisons were made with persons who had a mental disorder that did not meet these criteria (non-SMI). Soci odemographic factors, and 1-year volume and intensity of mental or addictiv e services use were determined. Differences between those who used services and those who did not were examined using logistic regression. Results: Pe rsons with SMI differed from persons with non-SMI in most sociodemographic characteristics. A higher proportion of persons with SMI used ambulatory se rvices, but the mean number of visits per person did not differ from the no n-SMI population. Persons with SMI comprised the bulk of hospital inpatient s admitted during a 1-year period. Several significant sociodemographic det erminants of service use were found, with different patterns for general me dical and specialty service use, pointing out potential barriers to care. C onclusions: As health care reform measures continue to be debated, attentio n to the service needs of the severely mentally ill is of crucial importanc e. Pre-managed care (pre-1993) baseline service use benchmarks will be esse ntial to assess the impact of managed care on access to care, particularly for the severely mentally ill. Periodic collection of epidemiologic data on prevalence and service use would thus greatly facilitate service planning and addressing barriers to receiving mental health services in this populat ion.