Search tips
Search criteria 


Logo of pubhealthrepPublic Health Reports
Public Health Rep. 1984 Sep-Oct; 99(5): 483–492.
PMCID: PMC1424630

Epidemiology and health service resource allocation policy for alcohol, drug abuse, and mental disorders.


Data from the NIMH Epidemiologic Catchment Area (ECA) Study in Baltimore, Md., are used to illustrate the association between alcohol, drug abuse, and mental disorder diagnoses with health service use. A probability sample of 3,481 adult (age 18 and over) residents of a geographically defined Baltimore City population of 175,000 was found to have a 23.4 per 100 population, 6-month prevalence of 13 specific alcohol, drug, and mental disorders. Of this population, 7.1 percent sought outpatient mental health treatment from both general medical physicians and mental health specialists in a 6-month period. The presence of a mental disorder diagnosis increased the average number of visits to all health providers from 1.91 to 4.06 during the same 6-month period. Although the presence of a mental disorder diagnosis clearly increased the probability of using both general medical and mental health services, only 15.6 percent of the persons with a mental disorder sought any mental health treatment during this 6-month timeframe--leaving 84 percent of those with mental disorders not seeking any outpatient treatment during the same period. The addition of a measure of high symptomatology (a score of 4 or more on the General Health Questionnaire) increased the percentage of persons with mental disorder using services to 30.5 percent. When a measure of disability was added to the diagnosis and the high symptom level score, 54.7 percent of the population could be predicted to use some mental health service. These data demonstrate the necessity of having additional patient assessment measures with a diagnosis to predict probable service use. However, even in the most comprehensive multidimensional model, more research is required to explore the phenomena of presumed unmet need--the 45 percent of those with a diagnosis, disability, and high symptoms who do not use services. Hence, epidemiologists who wish to participate in setting policy for resource allocation must join with their colleagues in economics, sociology, and health services research to identify all factors in addition to disease states that either predispose population groups to use services or represent additional resource allocation needs.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Regier DA, Goldberg ID, Taube CA. The de facto US mental health services system: a public health perspective. Arch Gen Psychiatry. 1978 Jun;35(6):685–693. [PubMed]
  • Ingham JG, Miller PM. The concept of prevalence applied to psychiatric disorders and symptoms. Psychol Med. 1976 May;6(2):217–225. [PubMed]
  • Rosen BM, Goldsmith HF. The health demographic profile system: current and longitudinal data base for social area analysis. Eval Program Plann. 1981;4(1):57–73. [PubMed]
  • Taube C, Lee ES, Forthofer RN. Diagnosis-related groups for mental disorders, alcoholism, and drug abuse: evaluation and alternatives. Hosp Community Psychiatry. 1984 May;35(5):452–455. [PubMed]
  • Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981 Apr;38(4):381–389. [PubMed]
  • Robins LN, Helzer JE, Ratcliff KS, Seyfried W. Validity of the diagnostic interview schedule, version II: DSM-III diagnoses. Psychol Med. 1982 Nov;12(4):855–870. [PubMed]
  • Eaton WW, Regier DA, Locke BZ, Taube CA. The Epidemiologic Catchment Area Program of the National Institute of Mental Health. Public Health Rep. 1981 Jul-Aug;96(4):319–325. [PMC free article] [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]

Articles from Public Health Reports are provided here courtesy of SAGE Publications