“After years of increasing reliance on psychiatric medications in American mental health care, the trend is shifting back toward psychotherapy,” said Mark Olfson, MD, MPH, professor of Epidemiology and Psychiatry at Columbia University’s Mailman School of Public Health.

Between 2018 and 2021, the proportion of adults receiving outpatient mental health care who used only psychotherapy rose from 11.5% to 15.4%. At the same time, those using only psychiatric medications declined from 68% to 62%. There was also a notable rise in psychotherapy visits and national spending on psychotherapy—from $31 billion to $51 billion alongside a decrease in the percentage of psychotherapy patients treated by psychiatrists, which dropped from 41% to 34%. Common psychiatric medications included antidepressants, antipsychotics, stimulants and other ADHD drugs, anxiolytics or hypnotics, and mood stabilizers, all obtained through pharmacies during the survey year.

Most of these shifts occurred between 2018 and 2019, suggesting that factors beyond the COVID-19 pandemic and growth in telemental health contributed to the change in outpatient mental health care. During the study period, the average number of visits increased for patients experiencing mild to moderate psychological distress, but not for those with severe mental health issues.

The findings are based on data from the 2018–2021 Medical Expenditure Panel Survey, which included responses from 17,821 adults with outpatient mental health visits, of whom 6,415 had psychotherapy sessions. The study analyzed trends among those receiving psychotherapy only, medication only, or both.

“Psychiatrists are now providing psychotherapy to a smaller share of patients, which may be prompting more referrals and collaboration with non-physician therapists,” Olfson noted. “Meanwhile, social workers and counselors though not psychologists have taken on a larger share of psychotherapy services. There’s also been an increase in the average number of sessions per patient, and fewer patients are dropping out after just one or two visits. This suggests Americans are not only more open to seeking therapy, but also more likely to stay engaged.”

Olfson added that the role of mental health counselors may expand further thanks to a recent change in Medicare policy that allows both counselors and licensed marriage and family therapists to bill for psychotherapy services.

Source: https://www.publichealth.columbia.edu/news/study-marks-rise-psychotherapy-outpatient-visits-declines-medication-use-mental-health-care