Patterns of use of ambulatory mental health services in a universal care setting

Objective. As health care expenditures grow, it is important to understand whether mental health sex-vices are being used appropriately. This study ex amined participants' reasons for seeking the services of a psychiatrist or psychologist to determine the extent to which factors other than an existin g clinical disorder, such as culture, stress, or lack of social support, pl ayed a role. Methods: A total of 1,257 randomly selected students who were enrolled at the University of Geneva in 1997 and who had unrestricted acces s to psychiatric services were asked how many times in the past 12 months t hey had consulted a psychiatrist or a psychologist. The respondents' mental health, perceived stress, self-esteem, sense of mastery, and social suppor t were measured with validated instruments. Results: A total of 131 respond ents (10 percent) reported an encounter with a mental health provider in th e past year. In adjusted analyses, female sex, Swiss citizenship, a higher level of stress, and a lower level of mental health were significantly asso ciated with a greater number of visits to a mental health specialist, and s elf-esteem, sense of mastery, and social support were not. Conclusions: The respondents' use of mental health services was determined by a lower level of mental health, indicating appropriate use of services based on clinical need. However, service use was also determined by consumer-related variabl es such as perceived stress and sociocultural characteristics.