Mental Health Care Increasing Most Among Those with Less Distress

Study reveals that fewer Americans have serious psychological distress, but those with less distress are getting more outpatient mental health treatment

New York, NY (November 28, 2018)—It sounds like good news: a new study shows that more Americans are getting outpatient mental health care and the rate of serious psychological distress is decreasing.

But a careful analysis of the data shows something more disconcerting: the growth in outpatient mental health care is being driven by people with little or no psychological distress, and many with serious distress don’t get the care they need.

The findings were published in JAMA Psychiatry.

“Our study shows there’s a mismatch in the U.S. between those with the greatest need who may not be getting mental health care they need and a growing number of Americans who are getting treatments—including psychiatric drugs—they may not need,” says Mark Olfson, MD, MPH, professor of psychiatry at Columbia University Vagelos College of Physicians and Surgeons and lead author of the paper.

The researchers analyzed data from a survey of nearly 140,000 US adults interviewed between 2004 and 2015. During that period, the overall percentage of American adults using any outpatient mental health care grew from 19 percent to 23 percent, even as the number of adults with serious psychological distress declined from 4.8 percent to 3.7 percent. The decrease in serious distress was smaller among those who received mental health care than those who didn’t, suggesting that mental health care wasn’t the reason for the decline in serious distress.

The researchers found that the proportion of those with serious psychological distress who received outpatient mental health care rose from 54 percent to 68 percent, while the proportion of those with less or no distress who received mental health care rose from 17 to 21 percent. But since fewer than 5 percent of the respondents had serious distress, they accounted for a significantly smaller portion of the overall increase in mental health care.

While psychiatric drug use increased from 50 percent to 64 percent among those with serious psychological distress, it also rose from 15 percent to 19 percent in those with less distress.

“We were encouraged to see greater overall use of mental health care, especially among those who need it most, though we were concerned about the increase in the proportion of individuals with less serious distress who are being treated with psychiatric drugs, which carry their own health risks,” Olfson says.

Many factors influence who seeks and receives mental health care, including awareness, sources of referral, access to mental health care, income and insurance status. However, the authors say it’s possible to reduce the mismatch between those who need mental health care and those who are getting it through measures that train primary care doctors to detect those with serious distress and refer those who need help for specialized treatment.

The study is titled, “Trends in serious psychological distress and outpatient mental health care of US adults.”

The other authors of this paper are Shuai Wang (Columbia University Irving Medical Center), Melanie Wall (Columbia), Steven C Marcus (University of Pennsylvania), and Carlos Blanco (National Institute on Drug Abuse).

The study was supported by the National Institute on Drug Abuse (DA019606).

Dr. Marcus reported receiving consulting fees from Alkermes, Allergan, Johnson & Johnson, SAFE Therapeutics, and Sunovion.

The authors report no additional financial or other conflicts of interest.


Columbia University Department of Psychiatry

Columbia Psychiatry is among the top ranked psychiatry departments in the nation and has contributed greatly to the understanding and treatment of brain disorders. Co-located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Irving Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at the Columbia University Vagelos College of Physicians and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, substance use disorders, and childhood psychiatric disorders.

Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit or