First contact with psychiatric services: who leaves and who remains

The objective of this study was to obtain information on patients in their first contact with community mental health departments in the south of Italy, particularly on dropout patients leaving care without a previous agreement.

A 3-month cohort of 265 "first-contact" psychiatric patients assisted at four different community mental health centers (CMHCs) was examined and followed up at 6 months.

The overall dropout rate after 6 months was 38.7%; it was higher for patients receiving pharmacological therapy alone and for patients seeking help on their own initiative, whereas physician-referred patients showed a lower dropout rate. More severely ill patients, as evaluated by physicians, showed dropout rates lower than those of patients "rating" themselves as severely ill.

To lower dropout rates in CMHC settings, physicians should be provided with more concrete support in the patient selection and referral process. Greater focus should be placed on patients' motivational aspects and on their perceptions of their own symptom severity, as well as on the risks of dispensing "easy" solutions such as pharmacological therapy alone.