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Cited by 284Mental Health Treatment and AccessPsychiatric care and mental health servicesMental Health and Patient Involvement

Disengagement from mental health services: A literature review

O’Brien, Aileen, Fahmy, Rana, Singh, Swaran P.·2009·Social Psychiatry and Psychiatric Epidemiology
DOI 10.1007/s00127-008-0476-0
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Abstract

This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.

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Authors
O’Brien, A., Fahmy, R., & Singh, S. P.
Affiliations
  • St George's, University of London (GB)
  • University of Warwick (GB)
Corresponding author
O’Brien, Aileen
ORCID
Venue
Social Psychiatry and Psychiatric Epidemiology
Publisher
Springer Science and Business Media LLC
Published
2008-11-26
Volume
44
Issue
7
Pages
558-568
ISSN
  • 0933-7954 (ISSN-L)
  • 1433-9285
DOI
10.1007/s00127-008-0476-0
OpenAlex
W2082092421
Cited by
283
References
133
Citations by year
2026: 5 · 2025: 18 · 2024: 9 · 2023: 18 · 2022: 16 · 2021: 18 · 2020: 19 · 2019: 23 · 2018: 20 · 2017: 21 · 2016: 14 · 2015: 22 · 2014: 20 · 2013: 26 · 2012: 17
FWCI
7.58
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
Keywords
patient engagement, engagement measurement, sociodemographic factors, lack of insight, substance abuse, forensic history, assertive outreach, continuity of care, severe mental illness, service availability
MeSH terms
Attitude to Health, Mental Disorders, Community Mental Health Services, Continuity of Patient Care, United Kingdom, Health Services Accessibility, Health Services Needs and Demand, Humans, Mental Health Services, Patient Acceptance of Health Care, Patient Dropouts, Research Design, Diagnosis, Dual (Psychiatry)

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