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Dropping out of care: inappropriate terminations of contact with community-based psychiatric services

Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Italy

GRAHAM THORNICROFT, MD

Health Services Research Department, Institute of Psychiatry, King's College London, UK

MICHELE TANSELLA, MD

Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Italy

Correspondence: Dr Alberto Rossi, Department of Medicine and Public Health, Section of Psychiatry, Ospedale Policlinico, Piazzale L.A. Scuro 10, 37134 Verona, Italy

Declaration of interest Funding was received from the Fondazione Cassa di Risparmio di Verona Vicenza Belluno e Ancona, Progetto Sanità 1996-1997.

Background Few studies have investigated factors which predict inappropriate terminations (drop-out) of clinical contact with mental health services.

Aims To identify patient and treatment characteristics associated with dropping out of contact with community-based psychiatric services (CPS).

Method A 3-month cohort of patients attending the CPS was followed up for 2 years, to identify drop-outs.

Results We identified 495 patients who had had at least one psychiatric contact of whom 261 had complete ratings for the Global Assessment of Functioning and the Verona Service Satisfaction Scale. In the year after the index contact, 70 terminated contact with the CPS; of these, 44 were rated as having inappropriate terminations (the ‘drop-out’ group) and 26 had appropriate terminations of contact. Drop-outs were younger, less likely to be married and their previous length of contact with services was shorter. No drop-outs had a diagnosis of schizophrenia. Multivariate analysis revealed predictors of dropping out.

Conclusions In a CPS targeted to patients with severe mental illnesses, those who drop out of care are younger patients without psychoses who are generally satisfied with their treatment.

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