Patterns and trends in mental health services use, dissemination implementation, and quality of care

A strategic line of research conducted by the MINT Program uses epidemiologic research to document the diminishing role of psychological treatments in mental health care, and to highlight the progressive expansion in recent years in use of off-label psychotropic regimens with unfavorable side effects to treat common disorders. For example, of great concern has been the sharp rise in antipsychotic prescriptions for anxiety disorders.  In one analysis, we found that antipsychotic prescriptions by psychiatrists for outpatient anxiety disorders increased from roughly 11% to 21%, meaning that currently 1 in 5 anxiety visits to a psychiatrist results in prescription of an antipsychotic medication.  The largest increases in antipsychotic prescribing for anxiety disorders were among new outpatients, indicating that psychiatrists appear increasingly comfortable prescribing antipsychotic medications for patients before initiating trials of other medication classes or adjusting current medications.

Growth in off-label antipsychotic prescribing is of particular concern, given the associated metabolic, endocrine, and cerebrovascular risks that have been well documented. In other work we have documented significant trends in the increased use of untested psychotropic polypharmacy to treat common childhood disorders—in these regimens multiple psychotropic medications from across different drug classes are co-prescribed in the absence of evidence supporting their safety and efficacy.

Representative MINT publications on patterns and trends in the broad use of mental health services and quality of care (for a complete list of studies, click here):

Sanchez, A.L., Cornacchio, D., Poznanski, B., Golik, A., Chou, T., & Comer, J.S. (2018). The effectiveness of school-based mental health services for elementary-aged children: A meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 57, 153-165.

Wiltsey-Stirman, S. & Comer, J.S. (2018). What are we even trying to implement? Considering the relative merits of promoting evidence-based practices, protocols, principles, or policy. Clinical Psychology: Science and Practice, 25, 1-3.

Gallo, K.P., Comer, J.S., Barlow, D.H., Clarke, R.N., & Antony, M.N. (2015). Direct-to-Consumer marketing of psychological treatments: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83, 994-998.

Comer, J.S., Mojtabai, R., & Olfson, M. (2011). National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders. American Journal of Psychiatry, 168, 1057-1065.

Comer, J.S., Olfson, M., & Mojtabai, R. (2010) National trends in child and adolescent psychotropic polypharmacy in office-based practice, 1996-2007. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1001-1010.

Comer, J.S., & Barlow, D.H. (2014). The occasional case against broad dissemination and implementation: Retaining a role for specialty care in the delivery of psychological treatments. American Psychologist, 69 1-18.

Barlow, D.H., Bullis, J.R., Comer, J.S., & Armetaj, A.A. (2013). Evidence-based psychological treatments: An update and the way forward. Annual Review of Clinical Psychology, 9, 1-27.

Gallo, K.P., Comer, J.S., & Barlow, D.H. (2013). Direct-to-consumer marketing of psychological treatments for anxiety disorders. Journal of Anxiety Disorders, 27, 793-801.