An organization applying the principles of "community context" had 20 dropouts among 111 African American and Hispanic patients in its mental health services. Its sister organization applying conventional psychiatric service approaches had 114 dropouts among 167 African American and Hispanic patients.

100 patients at a voluntary hospital who kept their first psychiatric appointments were compared on 31 variables with 100 patients who did not. Patients whose problems had become more acute prior to their appointment and those who mentioned some expectation of what was going to happen to them were more likely to have kept the appointments. The findings suggest the need for facilities where there is no waiting and also indicate the importance of quickly educating potential psychiatric patients about the nature of treatment.Previous studies have indicated that the breaking of psychiatric appointments is related to the distance of the psychiatric facility from the patient's home, the length of time from the initial request for help and when an appointment is made, the socio-economic class of the patient, and whether the patient's expectations of treatment are met. At The Roosevelt Hospital in New York City, some of these variables do not seem to be important factors. The hospital is a community mental health center serving a catchment area around its hospital location, and the distance any patient would have to travel is within less than a 2-mi. radius. Through group intake procedures no patient waits very long for an initial psychiatric appointment; the median waiting time is six days, and only about 2% of patients wait more than 2 wk. Yet despite these relatively near distances to the hospital and relatively short waiting periods, during some months more than half of the patients who call the hospital for psychiatric help do not show up for the initial appointment. Furthermore, fewer than 4% of those who miss initial appointments call the hospital for another appointment. This state of affairs has serious implications for meeting the emotional problems of people residing in the hospital's catchment areaThe present investigation attempted to study a number of variables for their possible relationship to whether a patient keeps or does not keep his initial appointment. Starting at the beginning of the calendar year of 1969, the first 100 patients who contacted the hospital for psychiatric help and arrived at their first scheduled appointment were interviewed at the hospital through a structured interview schedule. The schedule included variables that the psychiatric staff felt might be important, such as the waiting period for appointment, the referral source, the occupation of the patient, the patient's educational level, his marital status, why he was requesting help, the duration of his psychiatric problems and what his expectations were. The variables selected came from vari-'Dr. Gottesfeld is currently at the New York City Health and Hospitals Corporation.

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