To describe the profile of the intensive use of mental health services over a 4-year period in a population of 1.1 million people.
Methods:
Data obtained from computerized hospital separation records and physician reimbursement claims were combined to form patient-based histories of mental health care utilization. Users of mental health services in a 24-month period were hierarchically classified as having a psychotic disorder (ICD-9-CM 295–299) or a nonpsychotic disorder (ICD-9-CM 300–301, 306–309, 311). Intensive use was defined as 12 or more contact months or a minimum of 2 episodes of therapy in the 24-month period. The cohort of intensive users were followed over the subsequent 24-month interval to describe the persistence of intensive use.
Results:
In the initial observation period, intensive users constituted 27.4% of individuals in treatment for psychotic disorder and 4.4% of persons in treatment for nonpsychotic disorder. These 2 groups, which represent 7.4% of all users of mental health care, were responsible for 53% of physician services, 72.7% of contacts with psychiatrists, and 64.4% of acute psychiatric bed days in the initial period. In the follow-up period, intensive use status was replicated by 44.6% of the cohort.
Conclusions:
The diagnostic and therapeutic characteristics of intensive users of mental health services are heterogeneous. There is substantial persistence of intensive mental health service use over time.
References
1.
AndersonGKnickmanJR. Patterns of expenditures among high utilizers of medical care services. Med Care1984;22:143–149.
2.
ZookCJMooreFD. High-cost users of medical care. N Engl J Med1980;302:996–1002.
3.
McFarlandBHFreebornDK, Mullooly JP, and others. Utilization patterns among long-term enrollees in a prepaid group practice health maintenance organization. Med Care1985;23:1221–1233.
4.
LipzinBRegierDAGoldbergID. Utilization of health and mental health services in a large insured population. Am J Psychiatry1980;137:553–558.
5.
RoosNPShapiroETateRB. Does a small minority of elderly account for a majority of health care expenditures? A sixteen year perspective. Milbank Mem Fund Q1989;67:347–369.
6.
McGuireTGFairbankA. Patterns of mental health utilization over time in a fee-for-service population. Am J Public Health1988;78:134–136.
7.
KesslerLG. Treated incidence of mental disorders in a prepaid group practice. Am J Public Health1984;74:152–154.
8.
KatonWVon KorffMLinE, and others. Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry1990;12:355–362.
9.
JohnsonJWeismannMMKlermanGL. Service utilization and social morbidity associated with depressive symptoms in the community. J Am Med Assoc1992;267:1478–1483.
10.
TaubeDAGoldmanHH, Burns BJ, and others. High users of outpatient mental health services, I: Definition and characteristics. Am J Psychiatry1988;145:19–24.
11.
GoldmanHTaubeCA. High users of outpatient mental health services, II: Implications for practice and policy. Am J Psychiatry1988;145:24–28.
12.
FrankRGMcGuireTG. A review of studies of the impact of insurance on the demand and utilization of specialty mental health services. Health Serv Res1986;21:241–265.
13.
BarkerPRManderscheidRW, Hendershot GE, and others. Serious mental illness and disability in the adult household population: United States, 1989. Advance data from vital and health statistics; no 218 Hyattsville MD: National Center for Health Statistics; 1992.
14.
GoldmanHHGattozziAATaubeCA. Defining and counting the chronically mentally ill. Hosp Community Psychiatry1981;32:21–27.
15.
BlandRC. Long term mental illness in Canada: An epidemiological perspective on schizophrenia and affective disorders. Can J Psychiatry1984;29:242–246.
16.
RegierDANarrowWE, Rae DS, and others. The de facto US mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry1993:50;85–94.
17.
TatarynDMustardCADerksenS. Mental health profile of Manitobans and the utilization of mental health care services. Report 94.02. Manitoba Centre for Health Policy and Evaluation, Winnipeg, Manitoba; 1994.
18.
MustardCRoosNP. The relationship of prenatal care and pregnancy complication to birthweight outcome: Results from Winnipeg, Canada. Am J Public Health1994;84:1450–1457.
19.
RoosNPWennbergJE, Malenka DJ, and others. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med1989;320:1120–1124.
20.
RoosNPFlowerdewG, Wajda A, and others. Variations in physicians' hospitalization practices: A population-based study in Manitoba Canada. Am J Public Health1986;76:45–51.
21.
RoosNPHavensBBlackC. Living longer but doing worse: Assessing health status in elderly persons at two points in time in Manitoba, Canada, 1971 and 1983. Soc Sci Med1993;36:273–282.
22.
RoosLLNicolJPCageorgeSM. Using administrative data for longitudinal research: Comparisons with primary data collection. J Chron Dis1987;40:41–49.
23.
RoosLLRoosNP, Cageorge SM, and others. How good are the data? Reliability of one health care data bank. Med Care1982;20:266–276.
24.
WennbergJERoosNP, Sola L, and others. Use of claims data systems to evaluate health care outcomes: Mortality and reoperation following prostatectomy. J Am Med Assoc1987;257:933–936.
25.
American Psychiatric Association. Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed.Washington DC: American Psychiatric Association; 1980.
26.
RoosLLMustardCA, Nicol JP, and others. Registries and administrative data: Organization and accuracy. Med Care1993;31:201–212.
27.
WilkinsR. Use of postal codes and addresses in the analysis of health data. Health Rep1993;5:157–177.
28.
KellerMBLavoriPW, Mueller TI, and others. Time to recovery, chronicity and levels of psychopathology in major depression. Arch Gen Psychiatry1992;49:809–816.
29.
CoryellWEndicottJKellerM. Outcome of patients with chronic affective disorder: A five-year follow-up. Am J Psychiatry1990;147:1627–1633.
30.
KellerMBLavoriPW, Rice J, and others. The persistent risk of chronicity in recurrent episodes of nonbipolar major depressive disorder: A prospective study. Am J Psychiatry1986;143:24–28.
31.
FrankEKupferDJ, Perei JM, and others. Three-year outcomes for maintenance therapies for recurrent depression. Arch Gen Psychiatry1990;47:1093–1099.
32.
KellerMBKlermanGL, Lavori PW, and others. Long-term outcome of episodes of major depression. J Am Med Assoc1984;252:788–792.
33.
TaubeCAKesslerLGBurnsBJ. Estimating the probability and level of ambulatory mental health service use. Health Serv Res1986;21:321–340.
34.
WattsCASchefflerRMJewellNP. Demand for outpatient mental health services in a heavily insured population: The case of the Blue Cross and Blue Shield Association's Federal Employees Health Benefits Program. Health Serv Res1986;21:267–289.
