A longitudinal study of offset in the use of nonpsychiatric services following specialized mental health care

Med Care. 1983 Nov;21(11):1099-110. doi: 10.1097/00005650-198311000-00006.


This study examines the use of nonpsychiatric services by mentally ill persons following the receipt of specialized mental health care, frequently referred to as the "offset effect." A total of 9,761 persons enrolled during 1975 in the Columbia Medical Plan, a prepaid group practice in Columbia, Maryland, were studied over a 5-year period. Enrollees were classified into three groups: Treated--mental disorder diagnosis in 1975 and specialized mental health care in 1975; Untreated--mental disorder diagnosis in 1975 but no specialized mental health care in that year; and Comparison--neither mental disorder diagnosis nor specialized mental health care in 1975. The nonpsychiatric utilization for these groups was compared for 1973-1977. Specialized mental health care appears to have a short-term effect on nonpsychiatric utilization by attenuating the peak in use. Mentally ill persons without specialized mental health care in 1975 also reduced their use of nonpsychiatric services in 1976-1977. The utilization changes were more likely to occur in primary care departments, rather than nonpsychiatric specialty care departments. A diagnosis of mental disorder in either 1973 or 1974 was associated with a larger offset effect.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Analysis of Variance
  • Female
  • Group Practice, Prepaid / statistics & numerical data
  • Health Services / statistics & numerical data*
  • Humans
  • Longitudinal Studies
  • Male
  • Maryland
  • Medicine
  • Mental Disorders* / therapy
  • Mental Health Services*
  • Middle Aged
  • Primary Health Care / statistics & numerical data*
  • Psychotropic Drugs / therapeutic use
  • Sex Factors
  • Specialization


  • Psychotropic Drugs