Am J Psychiatry 1993; 150:625-631
Copyright © 1993 by American Psychiatric Association
The roles of psychiatrists in organized outpatient mental health settings
M Olfson, GL Klerman and HA Pincus
Department of Psychiatry, Cornell University Medical College, New York, NY.
OBJECTIVE: This paper describes the clinical roles of psychiatrists in U.S.
organized outpatient mental health settings. METHOD: 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. RESULTS: 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.
CONCLUSIONS: 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.
