The analysis of the utilization of mental healthcare services using routine data provided by statutory health insurance companies and pension funds is a way to assess the frequency of service use, the distribution of the service use among various healthcare settings (inpatients vs. outpatients, rehabilitation according mainly to the German Social Code Book IX vs. curative treatment according to the German Social Code Book V [note that some elements of rehabilitation are financed according to Social Code Book V as well]) and medical disciplines (psychiatry and psychosomatic medicine vs. somatic disciplines and general medicine). In addition, these data can provide information on the social consequences of mental disorders, as assessed by the number of cases and the duration of sick leave or case numbers of early retirement due to mental disorders. In this study, healthcare utilization data from 10 million Germans were analysed. Within a 3 year observation period (2005-2007), about one-third (approx. 3.3 million) persons had a contact with a healthcare service due to a diagnosis of the ICD-10 groups F0-F5. Given the large number of persons with depression in Germany, the initial results of an analysis of mental healthcare utilization due to depression are presented here. Among the study group of 3.3 million Germans with mental healthcare utilization within the observation period, 1.4 million had at least one contact to healthcare system due to the diagnosis of depression. In most cases, depression was diagnosed without specification of severity. It was found that non-psychiatric disciplines like general practitioners were the most frequently used providers in outpatient mental health care, whereas inpatient treatment predominantly occurred in psychiatric departments. For those persons with depression for which a severity-indicating ICD-10 code was used, it was found that utilization of psychiatric and psychosomatic disciplines increased in both in- and outpatient treatment compared to use of general medical facilities with more severe depression. Specialists for psychosomatic medicine and psychological psychotherapists predominantly treated cases of mild and moderate depression, whereas severe cases were mostly cared for by psychiatrists or psychiatric departments.

There was a high degree of comorbidity of mental and somatic illness. The fact that the vast majority of treatment was provided in the outpatient setting implies that cooperation across health-care sectors and disciplines should be reinforced, and that measures should be taken to ensure the adequate delivery of basic psychiatric care by primary care physicians.

For several years, there has been a significant increase of the utilization of health care due to mental disorders in Germany. Epidemiologic studies dealing with the prevalence of mental disorders show that the prevalence of mental disorders haven't increased. In consideration of the relative stable prevalence, currently there are only speculations about the reasons for the increasing service utilization. The capacity of psychiatric-psychosomatic-psychotherapeutic health care services is increasing. Despite the fact that capacity is increasing, in the outpatient and inpatient sector it comes apparent that there is an increasing burden, indicating that the demand for mental health care is not met by the capacity of psychiatric-psychosomatic-psychotherapeutic health care services. Health care provision by general practitioners and somatic disciplines predominate, going along with low cross-disciplinary and coordinated cooperation. So far, cooperative, intersectoral care models for mental disorders have been realized only in individual projects. Valid data are lacking, which need to reveal the causes and especially the consequences of this situation of mental health care provision and provide reference standards for an optimized, need-based care planning. For this reason, it is imperative to advance quality management for the care of mental disorders. With a view to the high rates of somatic comorbidity, an expansion of cooperative forms of mental health care appears essential.

With regard to the reform efforts in psychotherapeutic care, longitudinal trends in the utilization and quality of psychotherapeutic care in the individual fields of treatment should be analyzed in follow-up studies.