National trends in outpatient mental health service use among adults between 2008 and 2015

Objective: This study sought to characterize recent trends in mental health visits of adult outpatients to primary care physicians (PCPs), specialty mental health providers (SMHPs), and other providers (non-primary care physicians, specialists other than SMHPs, nurse practitioners, and physician assistants). Trends determined by degree of patients' psychological distress and in the types of treatments received within different settings were also examined. Methods: Data were from the household component of the nationally representative Medical Expenditure Panel Survey for the 2008-2011 and 2012-2015 periods for adults ages $18 years (N=13,111) who had a mental health outpatient visit. Bivariate logistic regression was used to compare means between the two periods. Results: The percentage of adults having mental health outpatient visits increased between the two periods, largely driven by an increase in visits with providers other than SMHPs and PCPs, which rose from 11.9% (N=667) to 15.5% (N=1,048). Outpatient mental health visits with PCPs decreased from 29.0% (N=1,802) to 26.8% (N=1,945). The proportion of respondents with mental health outpatient visits increased both among those with high psychological distress and among those with low or no psychological distress (from 30.7% [N=1,332] to 36.2% [N=1,491] and from 6.0% [N=4,516] to 6.9% [N=5,772], respectively). The percentage of respondents receiving only psychotropic medication decreased over the two periods. Conclusions: Mental health outpatient visits for adults increased between 2008 and 2015, and visits with SMHPs remained relatively stable during that time. A greater understanding of recent trends in types of outpatient mental health services may help identify targets for future mental health workforce studies.