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Between 2018 and 2021, the proportion of adults receiving outpatient mental health care that was solely psychotherapy rose, while the proportion of those taking only psychotropic medications declined, according to a study published yesterday in the American Journal of Psychiatry.
“Psychotherapy has long been viewed as a core clinical activity of mental health specialists,” wrote Mark Olfson, M.D., M.P.H., of the Columbia University Mailman School of Public Health and colleagues. “Between 1998 and 2007, however, there was a significant decline in the percentage of adult mental health outpatients in the United States who received psychotherapy either with or without psychotropic medications.”
Olfson and colleagues calculated national outpatient mental health care trends using data from the Medical Expenditure Panel Survey from 2018 to 2021, which included information on 17,821 outpatient mental health visits, including 6,415 psychotherapy visits. The data also included information on participants’ mental health conditions, such as depression, schizophrenia, and other disorders.
The estimated number of adults who received any outpatient mental health care increased from 11.2% in 2018 to 12.4% in 2021. Among this group:
- The percentage of patients who received psychotherapy without medications rose significantly from 11.5% in 2018 to 15.4% in 2021.
- The percentage of patients who received medications without psychotherapy dropped significantly from 67.6% in 2018 to 62.1% in 2021.
- The percentage of patients who received both medications and psychotherapy remained relatively stable (20.8% in 2018 and 22.5% in 2021).
There was a particularly notable rise in the use of psychotherapy only among patients treated for schizophrenia or related disorders—rising from 1.3% in 2018 to 16.6% in 2021; this rise was balanced by a significant drop in the percentage of patients treated with both psychotherapy and medications.
Olfson and colleagues noted that the largest single-year increase in the use of psychotherapy occurred between 2018 and 2019, so factors unrelated to the COVID-19 pandemic and the rise of telemedicine contributed to this trend.
The authors also found interesting changes in which health professionals were providing psychotherapy.
“Psychiatrists provided psychotherapy to a decreasing percentage of all psychotherapy patients, which may have increased the need for psychiatrists to refer patients to and collaborate with non-physician psychotherapists,” Olfson said in a news release. “At the same time, social workers and counselors, but not psychologists, assumed a larger role in providing psychotherapy.”
Olfson said this shift in providers may increase further following a recent change in Medicare reimbursement policy that allows mental health counselors and licensed marital and family therapists to bill for psychotherapy.
For related information, see the Psychiatric News article “Wither, Psychotherapy?”
(Image: Getty Images/iStock/Jacob Wackerhausen)
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