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Schizophrenia Bulletin Advance Access published online on June 2, 2009
Schizophrenia Bulletin, doi:10.1093/schbul/sbp046
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© The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Disengagement From Mental Health Treatment Among Individuals With Schizophrenia and Strategies for Facilitating Connections to Care: A Review of the Literature

Julie Kreyenbuhl13, Ilana R. Nossel4 and Lisa B. Dixon2,3
2 Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
3 Department of Veterans Affairs Capitol Healthcare Network (VISN 5) Mental Illness Research, Education and Clinical Center, Baltimore, MD
4 Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY

1 To whom correspondence should be addressed; Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 5th floor, 737 West Lombard Street, Baltimore, MD 21201; tel: 410-605-7466, fax: 410-605-7739, e-mail: jkreyenb{at}psych.umaryland.edu.

Disengagement from mental health services can lead to devastating consequences for individuals with schizophrenia and other serious mental illnesses who require ongoing treatment. We review the extent and correlates of dropping out of mental health treatment for individuals with schizophrenia and suggest strategies for facilitating treatment engagement. Although rates vary across studies, reviews of the literature suggest that up to one-third of individuals with serious mental illnesses who have had some contact with the mental health service system disengage from care. Younger age, male gender, ethnic minority background, and low social functioning have been consistently associated with disengagement from mental health treatment. Individuals with co-occurring psychiatric and substance use disorders, as well as those with early-onset psychosis, are at particularly high risk of treatment dropout. Engagement strategies should specifically target these high-risk groups, as well as high-risk periods, including following an emergency room or hospital admission and the initial period of treatment. Interventions to enhance engagement in mental health treatment range from low-intensity interventions, such as appointment reminders, to high-intensity interventions, such as assertive community treatment. Disengagement from treatment may reflect the consumer's perspective that treatment is not necessary, is not meeting their needs, or is not being provided in a collaborative manner. An emerging literature on patient-centered care and shared decision making in psychiatry provides suggestive evidence that efforts to enhance client-centered communication and promote individuals’ active involvement in mental health treatment decisions can also improve engagement in treatment.

Keywords: treatment dropout / serious mental illness / engagement strategies


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