Utilization of mental health services. Attrition versus aggregation.

Mental health services are utilized in the context of opposing trends of decline and accumulation in caseload. A rapid attrition in frequency of contact is counterbalanced by a slower aggregation of cases failing to reach termination. These opposite, simultaneous forces mean that a mental health service may be meeting its goal of containing the duration of treatment while its practitioners are contending with a sizable caseload resistant to closure. This phenomenon is empirically described.