The use of outpatient mental health services in the United States and Ontario: The impact of mental morbidity and perceived need for care

Objectives. This study compared the associations of individual mental health disorders, self-rated mental health, disability, and perceived need for care with the use of outpatient mental health services in the United States and the Canadian province of Ontario. Methods. A cross-sectional study design was employed. Data came from the 1990 US National Comorbidity Survey and the 1990 Mental Health Supplement to the Ontario Health Survey. Results. The odds of receiving any medical or psychiatric specialty services ere as follows: for persons with any affective disorder, 3.1 in the United States vs 11.0 in Ontario; for persons with fair or poor self-rated mental health. 2.7 in the United States vs 5.0 in Ontario; for persons with mental health-related disability, 3.0 in the United States vs 1.5 in Ontario. When perceived need was controlled for, most of the between-country differences in use disappeared. Conclusions. The higher use of mental health services in the United States than in Ontario is mostly explained by the combination of a higher prevalence of mental morbidity and a higher prevalence of perceived need for care among persons with low mental morbidity in the United States.