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Articles   |    
Disengagement From Care: Perspectives of Individuals With Serious Mental Illness and of Service Providers
Thomas E. Smith, M.D.; Alison Easter, Ph.D.; Michele Pollock, M.S.W.; Leah Gogel Pope, Ph.D.; Jennifer P. Wisdom, M.P.H., Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200394
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Dr. Smith is affiliated with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City, where Dr. Easter was affiliated at the time of this study, and with the New York State Psychiatric Institute, 1051 Riverside Dr., Unit 100, New York, NY 10032 (e-mail: tes2001@columbia.edu). Ms. Pollock is with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City. Dr. Pope is with the Nathan S. Kline Institute for Psychiatric Research, New York State Office of Mental Health, Orangeburg, New York. Dr. Wisdom is with the Department of Health Policy, George Washington University, Washington, D.C.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study sought to describe reasons for disengagement from services and practical guidelines to enhance engagement among individuals with serious mental illness and high need for treatment.

Methods  Qualitative interviews were conducted with 56 individuals with serious mental illness and 25 providers recruited from a larger project that used administrative data to identify individuals with serious mental illness who had disengaged from care. Individuals with serious mental illness and providers described reasons for disengagement and effective provider engagement strategies.

Results  Individuals with serious mental illness and providers differed in reported reasons for disengagement. Reasons reported by individuals with serious mental illness included services that were not relevant to their needs, inability to trust providers, and a belief that they were not ill. Providers cited lack of insight, stigma, and language and cultural barriers as common reasons for disengagement. Strategies for increasing engagement were grouped into a framework of acceptable, accessible, and available services. Acceptable services reflect a partnership model that fosters support and instills hope; accessible services minimize barriers related to transportation and intake procedures; and available services address recovery needs in addition to treatment of general medical and psychiatric problems.

Conclusions  Individuals with serious mental illness and providers often do not agree on reasons for seeking care. The framework of acceptable, accessible, and available services identifies opportunities for providers to adjust practices and maximize engagement in services among individuals with serious mental illness who are in high need of treatment.

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Table 1Characteristics of 56 individuals with serious mental illness who had disengaged from care
Table Footer Note

a Young adults (ages 18–24) without known criminal justice history were not asked about arrest history.

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Table 2Strategies identified by individuals with serious mental illness and providers to increase engagement in mental health services
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References

Kessler  RC;  Berglund  PA;  Bruce  ML  et al:  The prevalence and correlates of untreated serious mental illness.  Health Services Research 36:987–1007, 2001
[PubMed]
 
Wang  PS;  Demler  O;  Kessler  RC:  Adequacy of treatment for serious mental illness in the United States.  American Journal of Public Health 92:92–98, 2002
[CrossRef] | [PubMed]
 
Nosé  M;  Barbui  C;  Tansella  M:  How often do patients with psychosis fail to adhere to treatment programmes? A systematic review.  Psychological Medicine 33:1149–1160, 2003
[CrossRef] | [PubMed]
 
Kreyenbuhl  J;  Nossel  IR;  Dixon  LB:  Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: a review of the literature.  Schizophrenia Bulletin 35:696–703, 2009
[CrossRef] | [PubMed]
 
O’Brien  A;  Fahmy  R;  Singh  SP:  Disengagement from mental health services: a literature review.  Social Psychiatry and Psychiatric Epidemiology 44:558–568, 2009
[CrossRef] | [PubMed]
 
Olfson  M;  Mojtabai  R;  Sampson  NA  et al:  Dropout from outpatient mental health care in the United States.  Psychiatric Services 60:898–907, 2009
[CrossRef] | [PubMed]
 
Boyer  CA;  McAlpine  DD;  Pottick  KJ  et al:  Identifying risk factors and key strategies in linkage to outpatient psychiatric care.  American Journal of Psychiatry 157:1592–1598, 2000
[CrossRef] | [PubMed]
 
Fischer  EP;  McCarthy  JF;  Ignacio  RV  et al:  Longitudinal patterns of health system retention among veterans with schizophrenia or bipolar disorder.  Community Mental Health Journal 44:321–330, 2008
[CrossRef] | [PubMed]
 
Oliver  P;  Keen  J;  Rowse  G  et al:  The effect of time spent in treatment and dropout status on rates of convictions, cautions and imprisonment over five years in a primary care–led methadone maintenance service.  Addiction  105:732–739, 2010
[CrossRef] | [PubMed]
 
Priebe  S;  Watts  J;  Chase  M  et al:  Processes of disengagement and engagement in assertive outreach patients: qualitative study.  British Journal of Psychiatry 187:438–443, 2005
[CrossRef] | [PubMed]
 
Padgett  DK;  Henwood  B;  Abrams  C  et al:  Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: voices from the margins.  Psychiatric Rehabilitation Journal 31:226–233, 2008
[CrossRef] | [PubMed]
 
Green  CA;  Polen  MR;  Janoff  SL  et al:  Understanding how clinician-patient relationships and relational continuity of care affect recovery from serious mental illness: STARS study results.  Psychiatric Rehabilitation Journal 32:9–22, 2008
[CrossRef] | [PubMed]
 
Ware  NC;  Tugenberg  T;  Dickey  B:  Practitioner relationships and quality of care for low-income persons with serious mental illness.  Psychiatric Services 55:555–559, 2004
[CrossRef] | [PubMed]
 
Angell  B;  Mahoney  C:  Reconceptualizing the case management relationship in intensive treatment: a study of staff perceptions and experiences.  Administration and Policy in Mental Health and Mental Health Services Research 34:172–188, 2007
[CrossRef] | [PubMed]
 
Smith  TE;  Appel  A;  Donahue  SA  et al:  Use of administrative data to identify potential service gaps for individuals with serious mental illness.  Psychiatric Services 62:1094–1097, 2011
[CrossRef] | [PubMed]
 
Smith  TE;  Appel  A;  Donahue  SA  et al:  Public-academic partnerships: using Medicaid claims data to identify service gaps for high-need clients: the NYC Mental Health Care Monitoring Initiative.  Psychiatric Services 62:9–11, 2011
[CrossRef] | [PubMed]
 
Smith  TE;  Sederer  LI:  Changing the landscape of an urban public mental health system: the 2008 New York State–New York City Mental Health–Criminal Justice Review Panel.  Journal of Urban Health 87:129–135, 2010
[CrossRef] | [PubMed]
 
Cusack  KJ;  Morrissey  JP;  Cuddeback  GS  et al:  Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: a randomized trial.  Community Mental Health Journal 46:356–363, 2010
[CrossRef] | [PubMed]
 
Patel  V;  Flisher  AJ;  Hetrick  S  et al:  Mental health of young people: a global public-health challenge.  Lancet 369:1302–1313, 2007
[CrossRef] | [PubMed]
 
Smith  GR  Jr;  Rost  KM;  Fischer  EP  et al:  Assessing the effectiveness of mental health care in routine clinical practice: characteristics, development, and uses of patient outcomes modules.  Evaluation and the Health Professions 20:65–80, 1997
[CrossRef] | [PubMed]
 
Miles  M;  Huberman  AM:  Qualitative Data Analysis: An Expanded Sourcebook .  Thousand Oaks, Calif,  Sage, 1994
 
Friese S: ATLAS.ti 6 User Manual. Berlin, Germany, ATLAS.ti Scientific Software Development GmbH, 2011
 
Burns  T;  Catty  J;  Dash  M  et al:  Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression.  British Medical Journal 335:336, 2007
[CrossRef] | [PubMed]
 
Dixon  LB;  Dickerson  F;  Bellack  AS  et al:  The 2009 schizophrenia PORT psychosocial treatment recommendations and summary statements.  Schizophrenia Bulletin 36:48–70, 2010
[CrossRef] | [PubMed]
 
Killaspy  H:  Assertive community treatment in psychiatry.  British Medical Journal 335:311–312, 2007
[CrossRef] | [PubMed]
 
Marshall  M;  Lockwood  A:  Assertive community treatment for people with severe mental disorders.  Cochrane Database of Systematic Reviews 2:CD001089, 2000
[PubMed]
 
Druss  BG;  von Esenwein  SA;  Compton  MT  et al:  A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) Study.  American Journal of Psychiatry 167:151–159, 2010
[CrossRef] | [PubMed]
 
Simon  G:  Collaborative care for mood disorders.  Current Opinion in Psychiatry 22:37–41, 2009
[CrossRef] | [PubMed]
 
Brunette  MF;  Mueser  KT:  Psychosocial interventions for the long-term management of patients with severe mental illness and co-occurring substance use disorder.  Journal of Clinical Psychiatry 67(suppl 7):10–17, 2006
[CrossRef] | [PubMed]
 
Pescosolido  BA;  Gardner  CB;  Lubell  KM:  How people get into mental health services: stories of choice, coercion and “muddling through” from “first-timers.” Social Science and Medicine 46:275–286, 1998
[CrossRef] | [PubMed]
 
Salyers  MP;  Stull  LG;  Rollins  AL  et al:  The work of recovery on two assertive community treatment teams.  Administration and Policy in Mental Health and Mental Health Services Research 38:169–180, 2011
[CrossRef] | [PubMed]
 
Adams  JR;  Drake  RE:  Shared decision-making and evidence-based practice.  Community Mental Health Journal 42:87–105, 2006
[CrossRef] | [PubMed]
 
Deegan  PE;  Rapp  C;  Holter  M  et al:  Best practices: a program to support shared decision making in an outpatient psychiatric medication clinic.  Psychiatric Services 59:603–605, 2008
[CrossRef] | [PubMed]
 
Drake  RE;  Deegan  PE;  Rapp  C:  The promise of shared decision making in mental health.  Psychiatric Rehabilitation Journal 34:7–13, 2010
[CrossRef] | [PubMed]
 
Goss  C;  Moretti  F;  Mazzi  MA  et al:  Involving patients in decisions during psychiatric consultations.  British Journal of Psychiatry 193:416–421, 2008
[CrossRef] | [PubMed]
 
Schauer  C;  Everett  A;  del Vecchio  P  et al:  Promoting the value and practice of shared decision-making in mental health care.  Psychiatric Rehabilitation Journal 31:54–61, 2007
[CrossRef] | [PubMed]
 
Ware  NC;  Hopper  K;  Tugenberg  T  et al:  Connectedness and citizenship: redefining social integration.  Psychiatric Services 58:469–474, 2007
[CrossRef] | [PubMed]
 
Stanhope  V;  Henwood  BF;  Padgett  DK:  Understanding service disengagement from the perspective of case managers.  Psychiatric Services 60:459–464, 2009
[CrossRef] | [PubMed]
 
Davidson  L;  Drake  RE;  Schmutte  T  et al:  Oil and water or oil and vinegar? Evidence-based medicine meets recovery.  Community Mental Health Journal 45:323–332, 2009
[CrossRef] | [PubMed]
 
Corrigan  PW;  Angell  B;  Davidson  L  et al:  From adherence to self-determination: evolution of a treatment paradigm for people with serious mental illnesses.  Psychiatric Services 63:169–173, 2012
[CrossRef] | [PubMed]
 
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