What happens to patients seen only once by psychiatric services? Findings from a follow-up study

Abstract

Background and aims:

The aims of this study was to identify patient characteristics associated with once-only contact with a community-based mental health service (CMHS), and to re-evaluate these patients 3 months after the contact.

Methods:

A 33-month cohort of new episodes of care was followed-up to identify and interview once-only contact patients.

Results:

Of the 1,101 patients who met the study criteria, 165 (15%) were discharged after the first contact, 87 (8%) dropped out after the first contact, 440 (40%) were low users and 409 (37%) were high users of the CMHS in the 90 days after the first contact. A higher GAF score, less severe psychiatric diagnoses and lower socioeconomic status were the factors most associated with once-only contact at baseline. At follow-up clinical conditions of patients who had only one contact (both discharged and drop-out) had improved and, in most cases, they were in contact with other services. Drop-out patients, however, were more unwell and less satisfied with the initial contact.

Conclusions:

Although there is no way of knowing the status of patients who could not be located, information from the people interviewed suggest that, for a group of patients predominantly without psychoses, dropping out of contact after the first visit is associated with being less satisfied with the services received at the initial contact. This dissatisfaction may had lead these patients seeking help elsewhere. Perhaps, some of these extremely low users are in need of a different or more specialized clinical treatment approach.