Talk therapy is up, and use of psych meds without therapy is down, a study finds

More American adults with mental health needs have been getting talk therapy in recent years, according to a new study published in the American Journal of Psychiatry. The study also found that the number of people using only psychiatric medications for treatment declined for the first time in years.

“We’re seeing that during this time, this increase represents a period where psychotherapy is assuming a more important role in outpatient mental health care,” says Dr. Mark Olfson, a psychiatrist and epidemiologist at Columbia University.

“The number of American adults who receive psychotherapy went up from about 6.5% in 2018, up to 8.5% in 2021,” he says. “So that’s increased from about 16.5 million to nearly 22 million people.”

The findings mark a significant change from patterns of previous years, explains Olfson, who is the study’s lead author.

Since the late 1990s, use of talk therapy first declined, then plateaued. It was also a time when use of psychiatric medications rose.

“What we’d seen going all the way back to the late 1980s when Prozac first came on the scene, and the other antidepressants like the SSRIs followed,” adds Olfson, “medications had assumed a more and more important role in the delivery of outpatient mental health care.”

But between 2018 and 2021, he and his team found that among adults receiving outpatient mental health care, those using only medication declined from 67.6% to 62.1%. At the same time, the percentage of patients who received only talk therapy (without medications) grew. They found this trend among people with depression, anxiety and trauma and stressor-related disorders.

Another positive finding of the study was that more people stuck to therapy after starting it. The study recorded more visits in a year for new patients than in previous years.

“Overall, it suggests that psychotherapy [is] becoming more accessible to people and people are able to take advantage of it,” says Olfson. It might also reflect greater awareness about talk therapy and what to expect from it, says psychiatrist Dr. Jessi Gold, chief wellness officer at the University of Tennessee System.

“I think if you are more aware of what even therapy looks like, you don’t expect yourself to be fixed immediately or you don’t turn off from it immediately,” she says. Even though the trends documented in the new study started in 2019, the COVID-19 pandemic also made people more open to talking about mental health and seeking care, adds Gold.

Telehealth is part of the picture

And pandemic-era expansion of telehealth likely helped more people access talk therapy, as documented in the study.

“I think telehealth did increase access for people who might not have had any access to a therapist in their particular location or times,” says Gold. “I think access has definitely increased, but so has conversation around this.” 

Both Olfson and Gold point to another key finding in the new study: that the kinds of providers who are doing talk therapy have also expanded to include licensed counselors and social workers, as opposed to only psychiatrists and psychologists in previous years.

“When you have a demand and a need for access, creative models come into play,” says Gold. “We have really looked at how to increase access and increase models of care, and that doesn’t always require an M.D. or a Ph.D.”

Access is still a problem, though

However, Olfson notes that he and his colleagues found that the people who benefited the most from this increased access to talk therapy are mostly the affluent. “It’s among people that have more education, private insurance. They have a higher income; they tend to be in urban areas,” he says. “Those are the people who are benefiting most.”

He hopes the findings are used to help improve access to mental health care for people with less means.

According to the National Institute of Mental Health, the most recent national survey shows that only about half of all Americans with any mental illness received care in the prior year.