Dropout, early termination and detachment from a public psychiatric clinic.

BACKGROUND: Dropout from an outpatient clinic is the loss of a patient to scheduled follow-up. Due to movement of mental health care to the community, adherence to ambulatory care is crucial to maintain stability among individuals with mental disorders. We hypothesized that patients drop out from ambulatory psychiatric care when regardless of the therapist's evaluation, they feel that they have recovered, or because they are dissatisfied with treatment. The aim was to examine the phenomenon of premature termination of treatment in a public community-based ambulatory psychiatric clinic serving a catchment area with a population of 200,000.

SUBJECTS AND METHODS: The study sample was drawn from patients who had at least one ambulatory therapy session during the previous five years, immediately or shortly following initial treatment and who were subsequently lost to follow-up. Participants completed a questionnaire that evaluated their satisfaction with treatment and described their reasons for early termination of treatment.

RESULTS: The sample included eighty-two patients. Eighty percent of the responders (N=65) terminated therapy on their own, and twenty percent (N=17) decided to end treatment together with their therapists.

DISCUSSION: Increased involvement of patients in treatment planning, duration and end of therapy, may improve attendance in ambulatory mental health care settings.

CONCLUSIONS: Though dropouts generally reported satisfaction with the ambulatory service, some explained early termination of treatment as being due to dissatisfaction with the therapist, the type of treatment or because of therapist turnover. Others terminated treatment because they felt their problems were solved or their conditions had improved, though therapists had determined otherwise.