The First Psychiatric Interview: Patients Who Do and Do Not Come

Abstract

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.

Initial Appointment Nonattendance in Child and Family Mental Health Clinics.

“…In direct contrast to these studies are the findings that children referred for developmental problems (Ross & Lacey, 1961) and externalizing behaviors, such as conduct disorder, oppositional defiant disorder, and attention deficit disorder (Viale, Rosenthal, Curtiss, & Marohn, 1984), were more likely to remain in treatment than to drop out. Another study (Gottesfeld & Martinez, 1972) looked at the acuteness of the described problem but was unable to report any conclusive findings.…”

Improving Initial Session Attendance of Substance Abusing and Conduct Disordered Adolescents: A Controlled Study

“…Although attendance in the initial session (intake) has been reported as high as 85% (Noonan, 1973), most studies have indicated less favorable results. In fact, when mental health services fail to implement interventions that are specifically designed to improve attendance, only 22 to 70% (usually about 50%) of patients have been found to attend their first scheduled session (Allan, 1988;Burgoyne, Acosta, & Yamamoto, 1990;Campbell, Scilagyi, Rodewald, Doane, & Roghmann, 1994;Gottesfeld & Martinez, 1972;Hershorn & Rivas, 1993;Hochstadt & Trybula, 1980;Kourany, Garber, & Tornusciolo, 1990;Levy & Claravall, 1977;McKernan, McKay, McCadam, & Gonzalez, 1996;Nazarian, Mechaber, Charney, & Coulter, 1974;Overall & Aronson, 1963;Parrish, Charlop, & Fenton, 1984;Raynes & Warren, 1971;Rosenberg & Raynes, 1973;Ross, Friman, & Christopherson, 1993;Shepard & Moseley, 1976;Smith, Wienman, & Wait, 1990;Swenson & Pakarik, 1988;Tantum & Klerman, 1979;Turner & Vernon, 1976;Webster, 1992). Initial session attendance in substance abuse clinics is also about 50% (Gariti et al, 1995), and substance abuse, young age, and antisocial behavior have all been found to be associated with missed appointments (Cohen & Richardson, 1970;Deyo & Inui, 1980;Matas, Staley, & Griffin, 1992).…”

A study of attendance and filling in of pre-appointment questionnaires in an outpatient clinical psychology service

“…Raynes & W arren (1971) noted that the client group was largely working class which could account for the low attendance rate, but this was not a variable they examined. Gottesfeld & Martinez (1972) examined a long list of clinical and demographic variables in an attempt to distinguish attenders (n=100) from non-attenders (n=31) at a psychiatric hospital out-patient clinic. Every client in the study was interviewed in person at hom e. No differences between attenders and non-attenders emerged except on two variables: clients whose problems had become m ore acute prior to their appointment and clients who had som e idea of what to expect were m ore likely to attend.…”