The International Consortium of Psychiatric Epidemiology (ICPE) has brought together mental health researchers from around the world to compare the prevalence of mental health disorders and the utilization of mental health services in a variety of settings. The analyses compare results on patterns of service utilization in four of the ICPE study sites: USA, Ontario, The Netherlands, and Puerto Rico. The goals of this chapter are the following: to present data on past-year mental health service use, and to discuss the practical and methodological issues to be considered when developing a core set of questions about people's use of psychiatric services for use in psychiatric epidemiological surveys.

Formal mental health care was significantly higher for The Netherlands (13.4%), similar for Puerto Rico and the USA (8.3% and 8.1%, respectively) and lowest for Ontario (6.6%). A cross-national comparison examining differences in level of need in relation to use of mental health services showed that the number of psychiatric disorders was a major determinant of the individual's interaction with the formal mental health care system in all four sites. Observed differences in the use of mental health services could be attributed to differences in individual factors, in provider characteristics and in health care systems between the countries. By combining data from several countries, the ICPE provides an analytical base for monitoring the equity of service systems for people with mental illness. This chapter is only the beginning of our efforts to understand cross-national differences in patterns of care.

This is the first report of the mental health services work group of the ICPE.