First contact with psychiatric services: who leaves and who remains.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Morlino
Massimo
M
Section of Psychiatry, Department of Neurosciences, University Medical School Federico II, 80131 Naples, Italy. morlino@unina.it
Buonocore
Mariafrancesca
M
Calento
Antonio
A
Ravel
Marco Giuseppe
MG
Schiavone
Vittorio
V
D000328:Adult; D003156:Community Mental Health Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000458:organization & administration; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration