Why do psychiatric patients attend or not attend treatment groups in the community: A qualitative study

Abstract

BackgroundNon-attendance of treatment groups in the community has been a long-standing problem in mental health care. It has been found to have financial ramifications for services, worsen outcomes for those that do not attend and negatively impact on therapeutic group processes. There is a need to gain a better understanding of patients’ reasons for attending or not attending. This study aimed to explore patient views on facilitators and barriers to the attendance of treatment groups in the community.MethodsThe study used interview data collected as part of three studies that investigated treatment groups for psychiatric patients in the community. Sixty-seven interview transcripts were analysed using the framework method.ResultsFive themes relating to facilitators of group attendance were identified: opportunity for autonomy; self-acknowledging need and therapist encouragement; optimal group format and safe environment; interest in content and enjoyment; actual and expected benefits of attendance. Four themes related to barriers: not being sufficiently informed; concerns about social interactions and the unknown; limited accessibility; and negative group dynamics.ConclusionTo facilitate attendance and reduce attrition to treatment groups in the community clinicians should address patient’s wishes for information, capture their interest in the group modality, and potentially offer a ‘trial’ session. Furthermore, they should make the group location and time as accessible as possible and create a moderately sized group of six to eight patients. In these groups, mutual respect, feelings of safety and encouragement appear essential to make patients feel they can benefit from attendance.

A qualitative study of service user non‐engagement in psychological therapy groups on acute mental health wards

“…In addition, this was a small exploratory study, due to its circumscribed setting to a narrow geographical area of the United Kingdom and small number of potential participants (group attendees). Our findings, however, do mirror the general themes arising from a larger study conducted in the community (Dilgul et al, 2018), supporting the constructive paradigm adopted in our stance for data analysis. Inpatient…”

“…To our knowledge, this is the first contemporary qualitative study in the United Kingdom that has been conducted in order to explore service users' perspectives on non-engagement with psychological therapy groups in the inpatient setting. We are only aware of one prior larger study with similar aims conducted by our research group, albeit focussing specifically on community-based groups (Dilgul et al, 2018). Themes identified in the present study were in line with those identified previously, including the need for service users to be informed about the groups, interactions with other participants and the crucial role of maintaining a safe environment.…”

“…Research to date suggests that uptake of psychology groups tends to be relatively low, despite the fact that many people paradoxically do request psychological interventions (Dilgul et al, 2018). It was clear from the data that although many participants expressed an open-minded approach to groups, and a keenness to attend groups for stimulation on the wards, there was a general sense of uncertainty about the time, regularity, content and therapeutic requirement of psychology groups.…”

“…While service users have attested to the value of engagement in psychology groups on mental health wards (Hajek, 2007) and frequently report a need for more psychological activities, difficulties with engagement (uptake and dropout) in psychology groups have been found across all mental health settings (Dilgul et al, 2018).…”

Mindfulness for psychosis groups; description and preliminary evaluation of a novel routine care pathway in Hong Kong

“…There may be several reasons for the low drop-out rate in the current study, including the ‘opt-in’ nature of the way the mindfulness group was offered, and the opportunity to try an orientation ‘taster’ session first. The importance of encouraging service user choice and a feeling of autonomy has been previously highlighted as a facilitating factor which promotes regular group attendance in a qualitative study of 67 people who had attended therapy groups in the community [ 40 ].…”