The roles of psychiatrists in organized outpatient mental health settings.

Abstract

This paper describes the clinical roles of psychiatrists in U.S. organized outpatient mental health settings. Data were analyzed from the 1986 National Institute of Mental Health Client/Patient Sample Survey. The authors determined the range, volume, and content of services provided to established outpatients treated by psychiatrists at six types of mental health organizations: state and county mental hospital clinics, general hospital mental health clinics, private psychiatric hospital clinics, U.S. Department of Veterans Affairs medical center mental health clinics, free-standing mental health clinics, and multiservice mental health organizations. The psychiatrists treated nearly one-half (48.2%) of the established outpatients in organized settings, more than any other discipline. Most of the psychiatrists' patients (68.3%) were also treated by other mental health professionals. Psychiatrists treated a greater proportion of the patients at hospital-based clinics (60.7%) than at clinics without hospital affiliations (43.6%). They also treated larger proportions of the patients with schizophrenia (77.9%), affective disorders (50.6%), or anxiety disorders (59.2%) than those with adjustment disorders (23.7%), substance use disorders (34.3%), or childhood mental disorders (29.5%). The patients treated by psychiatrists commonly received psychotropic medications (77.3%) and individual therapy (66.3%) but less commonly received group (20.7%), skills (11.9%), or family (5.9%) therapy. In organized outpatient settings, psychiatrists typically work with other mental health professionals to treat a select group of severely ill patients. However, there is considerable variation in the extent to which different types of mental health organizations rely on psychiatrists to provide clinical care.