Disengagement From Care: Perspectives of Individuals With Serious Mental Illness and of Service Providers

Abstract

Individuals with serious mental illness and providers often do not agree on reasons for seeking care. The framework of acceptable, accessible, and available services identifies opportunities for providers to adjust practices and maximize engagement in services among individuals with serious mental illness who are in high need of treatment.

Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review

“…Clinicians reported that Bangladeshi women in the UK [41], and Indian immigrants [45], elderly blacks and Hispanics [44], and Portuguese-speaking immigrants [50] in the United States discontinued medications perceived as unnecessary. However, black, Hispanic, and Asian patients in the US continued medications when clinicians confirmed with family members that the use of medications is a culturally-appropriate expectation of care [58]. The second commonest finding was that clinicians improved treatment continuation after framing communication according to patient interpretations.…”

Perspectives of Treatment Providers and Clients with Serious Mental Illness Regarding Effective Therapeutic Relationships

“…27 The study included clients identified in the New York City Mental Health Care Monitoring Initiative, a project jointly sponsored by the NYS Office of Mental Health and the NYC Department of Health and Mental Hygiene that operated from 2009-2011 as an effort to improve service coordination for adult NYC residents with serious mental illness. The project involved reviews of Medicaid claims and other state administrative data for high-need populations to identify clients who may not have been receiving needed services, or who used excessive amounts of acute behavioral health services.…”

“…28,29 Prior reports have summarized the project's findings regarding numbers of clients disengaged, reasons for disengagement, availability of treatment provider outreach, and re-engagement rates. 27,30,31 …”

“…Potentially eligible clients were identified using data from the NYC Care Monitoring Initiative. 27 A stratified purposive sampling approach was used to identify high risk clients who met the following criteria: age 18-65; and had a history of criminal justice involvement, mandated outpatient mental health services, or were young adults (between 18 and 24 years of age). These populations are among the most vulnerable and at high risk for disengagement and poor mental health/functional outcomes.…”

“…25,26 Prior work culminating from the current study outlined reasons for disengagement and characteristics of services that promote engagement among clients with serious mental illness who frequently discontinue services. 27 Clients reported that disengagement occurred due to services failing to meet their needs and difficulties with treatment provider relationships and trust, while treatment providers were more likely to view disengagement as part of an ongoing struggle with mental illness, a lack of family or community support and logistical barriers such as transportation. Characteristics of mental health services that support engagement were categorized as: acceptable (caring, strength-based approach); accessible (transportation assistance, flexibility); and available (job training, entitlements).…”