Demystifying the patient dropout: a study of 122 brief-stay day-treatment center admissions

Past studies examining the dropout from treatment phenomenon have failed to identify comparable populations or a standardized definition of the term "patient dropout." Although the phenomenon is widespread, few investigators have studied the problem within day-treatment programs serving subacutely disturbed clients in need of socialization or prevocational services. The primary purpose of the present study was to determine the reasons for brief Day Treatment Center (DTC) stays of 10 sessions or fewer and to ascertain implications of these findings for admission screening processes. Analysis of demographic information revealed that the average brief-stay patient was in his mid-thirties, was single (65%), was schizophrenic (39%) or suffering a mood disorder (27%), and had attended up to 4 days (63%) before leaving treatment. A retrospective review of 122 brief stay records revealed six categories of reasons for leaving the DTC: (1) a desire to return to work, (2) exacerbation of psychiatric symptoms, (3) resistance to treatment recommendations, (4) negative reaction to the treatment milieu, (5) a desire for less intense treatment, and (6) a belief that problems were resolved during the brief stay. The authors concluded that admission screening interviewers would benefit from complete past school and work records. Strategies for reducing dropout rates should include (1) longer transition periods for newly referred patients, (2) obligatory meetings with the patient and his family and therapist before inpatient discharge, and (3) improved orientation to the DTC program.