The proportion of people who reported 12-month mental health service use is higher now (17%) than compared to the 13% reported a decade ago in the baseline NCS survey (NIMH, 2005). The expansion was mainly in the general medical sector, with more primary care physicians providing psychiatric services.
In the NCS-R, people with mental or substance abuse disorders were more likely to get treatment from a primary care physician/nurse or other general medical doctor (22.8%), or from a nonpsychiatrist mental health specialist (16%), such as a psychologist, social worker or counselor, than from a psychiatrist (12%), though the survey did show that the adequacy of treatment (measured by number of visits) is best when provided by mental health practitioners. About 9.7% sought help from a counselor or spiritual advisor outside of a mental health setting; and 6.9% used a complementary/alternative source, such as a chiropractor or self-help group. This held true even for those with severe mood disorders.
Traditionally underserved groups, such as the elderly, racial/ethnic minorities, and those with low income or without insurance, had the greatest unmet need for treatment (NIMH, 2005).
"It is clear that given the current state of affairs, it is very difficult
for a primary care physician to deal with the massive influx of people who have
had mental health problems and are coming to them over this past decade. At the
same time, it is also clear that the number of psychiatrists in
One possible solution, he said, could involve having one psychiatrist run an organization that has, for example, four clinical psychologists and 10 social workers.
"There are people with different levels of severity ... who are getting treatment that makes sense, given the severity of their illness and where they are in their life course. The psychiatrist is someone who can intervene at all those levels, but is able to triage in a way that gives the appropriate amount of intervention," said Kessler, adding that such a service delivery model "is likely to evolve over the next decade."
Currently, the NCS-R provides a guide to what is happening in the