Variations in the intensity of psychiatric treatment across markets for mental health services in the United States.

Data are analyzed that describe the clinical work of 800 psychiatrists who practiced in one of 62 markets for mental health services in the United States during 1982 or 1983. Intensity of treatment (i.e., mean face-to-face treatment minutes per patient per month) ranges from a low of 107 minutes to a high of 368 minutes. Each of two multiple regression models accounts for 60 percent or more of the observed variation. Most of the variation in intensity of treatment can be accounted for with variables associated with the patient's severity or stage of illness and the type of treatment provided. Patients who fall on the midrange of the severity scale tend to consume the most treatment time per month. None of the economic variables were significant at any reasonable level. These findings have immediate implications for the development of more functional prospective payment systems for the financing of mental health care and for the longer-term debate over the nature of mental health services markets.