Disengagement from mental health services. A literature review.
ABSTRACT This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.
- SourceAvailable from: Simon WesselyBMJ Open 03/2015; 5(3):e007051-e007051. DOI:10.1136/bmjopen-2014-007051 · 2.06 Impact Factor
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ABSTRACT: This study assessed factors that facilitated or impeded clients' engagement in services offered by the Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program for youths and young adults experiencing early psychosis. It was part of the larger RAISE Implementation and Engagement Study. Thematic qualitative analyses of data from in-person, semistructured interviews with 32 clients were used to examine experiences of program services, staff practices, clients' engagement behaviors, and related factors, such as expectations, family involvement, illness, and setting. Eighteen clients were well engaged with services, and 14 were not. Thirteen were interviewed early in their program involvement (two to nine months after enrollment) and 18 others later (12 to 24 months after enrollment). Four domains of factors influenced engagement: individualized care, program attributes, family member engagement, and personal attributes. A central factor was the program's focus on clients' life goals. For many interviewees, engagement hinged substantially on receiving what could be considered nonclinical services, such as supported education and employment. Other key factors were individualized services and staff interactions that were respectful, warm, and flexible; engagement of family members; and a focus on shared decision making. The findings help explain the Connection Program's effectiveness regarding client engagement and deepen understanding of treatment engagement for youths and young adults experiencing early psychosis. The individualized, flexible, recovery-focused, and assertive model of services and client-staff interaction, incorporating shared decision making and a focus on client life goals, should be implemented and sustained in services for this population.Psychiatric services (Washington, D.C.) 04/2015; DOI:10.1176/appi.ps.201400475 · 1.99 Impact Factor
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ABSTRACT: Service disengagement is a pervasive challenge the mental health care system faces. Mental health services are of little value should persons with mental illnesses continue to opt out of receiving them. Consumers attribute disengagement from care to an absence of choice in their treatment. In response, the mental health system is adopting a person-centered model, based upon recovery principles, to engage consumers more actively in their care. Person-centered care planning is a promising practice involving collaboration to develop and implement an actionable plan to assist the person in achieving personal recovery goals. This study design combines a parallel-group randomized controlled trial of community mental health organizations with qualitative methods to assess the effectiveness of person-centered care planning. Participants at 14 sites in Delaware and Connecticut will be randomized to treatment as usual or the person-centered care planning intervention. Participants will be in leadership (n = 70) or supervisory or direct care (n = 210) roles. The person-centered care planning intervention involves intensive staff training and 12 months of ongoing technical assistance. Quantitative survey data will be collected at baseline, 6 months and 12 months measuringperson-centered care planning competency and organizational factors. Consumer outcomes (engagement, medication adherence, functioning and consumer satisfaction) will be assessed by Medicaid and state-level data. Qualitative data focused on process factors will include staff and consumer interviews and focus groups. In this intent-to-treat analysis, we will use mixed-effects multivariate regression models to evaluate the differential impact of the person-centered care planning intervention on each consumer and implementation outcome as well as the extent to which clinician assessments of organizational factors are associated with the implementation outcome. Mixed methods will triangulate and strengthen the interpretation of outcomes. The aim of this study is to generate valuable guidance for state systems engaged in scale-up and transformation efforts. Targeted staff selection for training to support sustainability will serve to provide further insight into important intervention implementation strategies. Person-centered care planning has the potential to enhance the impact of all evidence-based and recovery-oriented practices and bring practice into line with the emerging national guidelines in health care reform. This trial was registered with ClinicalTrials.gov (Identifier: NCT02299492 ) on 21 November 2014 as New York University Protocol Record PCCP-13-9762, Person-Centered Care Planning and Service Engagement.Trials 04/2015; 16(1):180. DOI:10.1186/s13063-015-0715-0 · 2.12 Impact Factor