Interventions to Increase Retention in Mental Health Services: A Systematic Review
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Search Methods
Selection Criteria
Selection of Studies
Data Extraction
Results
Description of Interventions
Intervention | Mental health problem | N | ||||||
---|---|---|---|---|---|---|---|---|
Study | Name | Target | Delivery | Setting | Design | Intervention | Control | |
Alegría et al., 2008 (27) | Right Question Project–Mental Health | Patient empowerment and patient activation | Depressive disorder, bipolar disorder, anxiety disorder, psychotic disorder, and other disorder | 3 sessions, 30 minutes each, over approximately 2 months | Community mental health clinic | Nonrandom comparison groups | 141 | 90 |
Alegría et al., 2014 (29) | DECIDE | Patient activation | Any mental health problem | 3 sessions, 30–45 minutes each, over a 3-month period | Community mental health clinic | Randomized controlled trial | 372 | 352 |
Alvidrez et al., 2005 (18) | Psychoeducation | Mental health knowledge and mental health attitudes | Any mental health problem | 1 session (15 minutes) | Geriatric health clinic | Nonrandom comparison groups | 32 | 37 |
Dixon et al., 2009 (19) | Brief critical time intervention | Barriers to treatment, needs assessment, emotional and practical support from clinician, and developing treatment goals | Schizophrenia spectrum disorder, major depression, bipolar disorder, or psychotic disorder not otherwise specified | 1 initial session followed by up to 3 months of contact at the patient’s home and in the community | Veterans Affairs Capitol Healthcare Network | Randomized controlled trial | 64 | 71 |
Grote et al., 2007 (23) | Pretreatment engagement interview and brief interpersonal psychotherapy (IPT) | Mental health knowledge, mental health attitudes, and barriers to treatment | Depression | 1 engagement session (45–60 minutes) and 8 IPT sessions | Obstetrics clinic | Randomized controlled trial | 25 | 28 |
McFall et al., 2000 (25) | Outreach | Mental health knowledge, mental health attitudes, and barriers to treatment | Posttraumatic stress disorder | 1 mailing, followed by a 15-minute telephone contact | na | Randomized controlled trial | 302 | 292 |
McMurran et al., 2013 (20) | Motivational interviewing and Personal Concerns Inventory procedure | Goal attainment via mental health treatment and patient motivation | Any mental health problem | 1 session (1.5 hours) | Personality disorder clinic | Randomized controlled trial | 17 | 24 |
Scott et al., 2009 (21) | Psychoeducation | Mental health knowledge | Bipolar disorder | 21 sessions, 1.5 hours each, over a 6-month period | Bipolar disorder clinic | Randomized controlled trial | 60 | 60 |
Sirey et al., 2005 (26) | Treatment Initiation Program | Mental health knowledge, mental health attitudes, barriers to treatment, and developing treatment goals | Depression | 3 sessions, 30 minutes each, during the first 6 weeks and 2 follow-up phone calls at 8 and 10 weeks | Geriatric psychiatry clinic | Randomized controlled trial | 26 | 26 |
Spooren et al., 1998 (24) | Various educational strategies, depending on the participant | Mental health knowledge, patient motivation, and family involvement | Any mental health problem | 30 minutes to 1.5 hours | Hospital | Randomized controlled trial | 327 | 322 |
Stecker et al., 2014 (22) | Brief, cognitive-behavioral intervention | Mental health attitudes | Posttraumatic stress disorder | 1 session, (45–60 minutes) via phone | na | Randomized controlled trial | 123 | 151 |
Target | Factors |
---|---|
Mental health knowledge | |
Alvidrez et al., 2005 (18) | Use of medical model of mental health problems to reduce stigma, the specific conditions under which involuntary hospitalization could occur, how therapists could be different from their clients and still be helpful, the receptivity of clinic therapists to discussing issues of religion or spirituality and incorporating them into the treatment, and the importance of the patient’s input in determining therapy goals and session topics |
Grote et al., 2007 (23) | Psychoeducation about mental health problem (for example, depression) and description of various treatment options |
McFall et al., 2000 (25) | Information describing available treatment services and assessing awareness of mental health resources |
Scott et al., 2009 (21) | Each psychoeducation session addresses a different aspect of bipolar disorder and treatment |
Sirey et al., 2005 (26) | Misconceptions about depression and treatment and cognitive distortions associated with depression |
Spooren et al., 1998 (24) | General explanation of further outpatient treatment and how patient could benefit from it |
Mental health attitudes | |
Alvidrez et al., 2005 (18) | Importance of talking with the therapist about conflicts, misunderstandings, or dissatisfaction with the treatment process |
Grote et al., 2007 (23) | Understanding patient’s experience of her mental health problem; exploring positive and negative aspects of previous coping mechanisms, especially previous mental health treatments; personal and familial attitudes regarding the stigma of depression and regarding receiving mental health care; and negative past experiences with professionals |
McFall et al., 2000 (25) | Attitudes toward mental health treatment and the Veterans Health Administration health care system |
Sirey et al., 2005 (26) | Perceived stigma and perceived need for care |
Stecker et al., 2014 (22) | Participants identify individual beliefs about mental health treatment during the intervention session; the intervention session addresses a maximum of three beliefs with each participant |
Barriers to treatment | |
Dixon et al., 2009 (19) | Assessment of barriers to outpatient mental health care |
Grote et al., 2007 (23) | Clinician addresses any barrier client raises, such as psychological or cultural barriers, and suggests some barriers, for example practical barriers, such as cost, transportation, child care, and scheduling |
McFall et al., 2000 (25) | Physical barriers to accessing care |
Sirey et al., 2005 (26) | Logistical barriers |
Patient empowerment | |
Alegría et al., 2008 (27) | Shared patient-provider decision making (empowerment) and preparation for appointments |
Patient activation | |
Alegría et al., 2008 (27) | Formulated questions to get information (activation) about patients’ mental health problems, treatments, and relationships with providers |
Alegría et al., 2014 (29) | Participants identify decisions regarding their mental health care, generate and refine questions for their health care professionals regarding these decisions, and promote interactions with health care professionals that allow for patient needs to be shared and addressed |
Goal attainment via mental health treatment | |
McMurran et al., 2013 (20) | Participants identify goals in 11 life areas (for example, relationships, work or education, home, and health) and prioritize 5 goals. Therapists rate goals on scales from 0 to 10 assessing 5 aspects of goal attainment (likelihood of attainment, control over attainment, knowing how to attain it, happiness upon attainment, and commitment to attaining it) |
Needs assessment | |
Dixon et al., 2009 (19) | Assess and address individual needs in 9 areas (systems coordination, engagement in psychiatric services, continuation of substance abuse treatment, medication adherence, family involvement and social support network, life skills training and support, integration of medical care, establishment of community linkages and practical needs assistance) |
Patient motivation | |
McMurran et al., 2013 (20) | In order to increase motivation to engage in therapy, participants identify obstacles to goal attainment and consider the possibility that therapy could help them overcome these obstacles |
Spooren et al., 1998 (24) | Counseling directed at increasing motivation and incorporating the patient’s perspective |
Emotional and practical support from clinician | |
Dixon et al., 2009 (19) | Clinician maintains a high level of patient contact, conducting home visits, accompanying the patient to initial appointments, and providing emotional and practical support for the patient and family |
Family involvement | |
Spooren et al., 1998 (24) | Informing family about the present illness or problems, the need for treatment, and the practical organization of the aftercare |
Developing treatment goals | |
Dixon et al., 2009 (19) | Clinician develops individualized treatment goals |
Sirey et al., 2005 (26) | Identifying treatment goals |
Effects of the Interventions
Study | Follow-up | Retention measure | Outcomes | Effect size |
---|---|---|---|---|
Alegría et al., 2008 (27) | 6 months | Retention in treatment (≥4 psychotherapy or psychopharmacology visits) | Intervention participants were over twice as likely as control participants to be retained in treatment (adjusted odds ratio=2.78, 95% confidence interval=1.33–5.79); proportions retained in treatment were not reported | .56 |
Alegría et al., 2014 (29) | 6 months | Retention in treatment (≥4 psychotherapy or psychopharmacology visits) | Intervention participants were no more likely than control participants to be retained in treatment; proportions retained in treatment were not reported | No effecta |
Alvidrez et al., 2005 (18) | 3 months | Mean N of psychotherapy sessions attended | 3.5 sessions for the intervention group vs. 1.9 sessions for the control group | .76 |
Dixon et al., 2009 (19) | 30 days | Mean N of mental health or substance abuse visits in the first 30 days after discharge | 6.67 visits for the intervention group vs. 1.97 visits for the control group | 1.50 |
180 days | Mean N of mental health or substance abuse visits in the first 180 days after discharge | 20.80 visits for the intervention group vs. 10.08 visits for the control group | .80 | |
180 days | Mean N of 60-day periods with ≥2 mental health or substance abuse visits in the first 180 days after discharge | 2.23 60-day periods for the intervention group vs. 1.62 60-day periods for the control group | .60 | |
Grote et al., 2007 (23) | na | Proportion of participants completing full course of treatment | 17 of 25 (68%) completers for the intervention group vs. 2 of 28 (7%) completers for the control group | 1.90 |
McFall et al., 2000 (25) | 6 months | Percentage of participants attending ≥1 follow-up treatment sessionsb | 19.4% for the intervention group vs. 5.8% for the control group | .41 |
McMurran et al., 2013 (20) | 3 months | Mean N of treatment sessions | 8.18 sessions for the intervention group vs. 6.54 sessions for the control group | .38 |
3 months | Of treatment sessions offered, median percentage attended | 83.3% for the intervention group vs. 66.7% for the control group | .44 | |
Scott et al., 2009 (21) | 6 months | Mean N of outpatient visits | 3.13 visits for the intervention group vs. 2.48 visits for the control group | .23 |
6 months | Mean N of therapy sessions | 17.62 sessions for the intervention group vs. 17.25 sessions for the control group | .11 | |
5 years | Mean N of outpatient visits | 17.27 visits for the intervention group vs. 8.59 visits for the control group | .64 | |
5 years | Mean N of therapy sessions | 17.92 sessions for the intervention group vs. 12.63 sessions for the control group | .86 | |
Sirey et al., 2005 (26) | 3 months | Proportion remaining in treatment | More intervention participants than control participants remained in treatment (p=.05, two-tailed Fisher’s exact test); proportions remaining in treatment were not reported | .57 |
6 months | Proportion remaining in treatment | More intervention participants than control participants remained in treatment (p=.04, two-tailed Fisher’s exact test); proportions remaining in treatment were not reported | .59 | |
6 months | Mean N of pharmacotherapy visits | No differences between groups (mean visits were not reported) | .15 | |
6 months | Mean N of psychotherapy sessions | No differences between groups (mean sessions were not reported) | .02 | |
Spooren et al., 1998 (24) | 4 months | Proportion of participants in hospital A who were deemed treatment compliant (continuation of outpatient treatment and keeping appointments on a regular basis) | 52 of 107 (48.6%) intervention participants vs. 23 of 105 (21.9%) control participants | .67 |
Proportion of participants in hospital B who were deemed treatment compliant (continuation of outpatient treatment and keeping appointments on a regular basis) | 39 of 120 (32.5%) intervention participants vs. 38 of 112 (33.9%) control participants | –.04 | ||
Proportion of participants in hospital C who were deemed treatment compliant (continuation of outpatient treatment and keeping appointments on a regular basis) | 31 of 99 (30.6%) intervention participants vs. 11 of 105 (10.5%) control participants | .75 | ||
Stecker et al., 2014 (22) | 1 month | Mean N of treatment sessions | .38 sessions for the intervention group vs. .20 sessions for the control group | .24 |
3 months | Mean N of treatment sessions | 1.08 sessions for the intervention group vs. .67 sessions for the control group | .23 | |
6 months | Mean N of treatment sessions | 4.06 sessions for the intervention group vs. 2.47 sessions for the control group | .19 |
Mental health knowledge.
Mental health attitudes.
Barriers to treatment.
Patient empowerment.
Patient activation.
Other targets.
Summary of effects.
Methodological Quality
Study | Study design | Study score | Quality indicator rating | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
QR | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |||
Alegría et al., 2008 (27) | Nonrandom comparison groups | 13 | Fair | 0 | 0 | 0 | 0 | 2 | 3 | 2 | 3 | 0 | 3 |
Alegría et al., 2014 (29) | Randomized controlled trial (RCT) | 20 | Fair | 3 | 0 | 0 | 0 | 3 | 3 | 2 | 3 | 3 | 3 |
Alvidrez et al., 2005 (18) | Nonrandom comparison groups | 16 | Fair | 3 | 0 | 0 | 0 | 2 | 2 | 3 | 3 | 0 | 3 |
Dixon et al., 2009 (19) | RCT | 17 | Fair | 0 | 3 | 0 | 0 | 2 | 3 | 1 | 2 | 3 | 3 |
Grote et al., 2007 (23) | RCT | 15 | Fair | 0 | 0 | 0 | 0 | 2 | 2 | 2 | 3 | 3 | 3 |
McFall et al., 2000 (25) | RCT | 24 | Good | 3 | 3 | 3 | 0 | 3 | 2 | 3 | 1 | 3 | 3 |
McMurran et al., 2013 (20) | RCT | 18 | Fair | 3 | 3 | 0 | 0 | 3 | 2 | 3 | 1 | 0 | 3 |
Scott et al., 2009 (21) | RCT | 20 | Fair | 3 | 0 | 3 | 3 | 3 | 2 | 3 | 0 | 0 | 3 |
Sirey et al., 2005 (26) | RCT | 18 | Fair | 0 | 3 | 0 | 3 | 3 | 3 | 0 | 0 | 3 | 3 |
Spooren et al., 1998 (24) | RCT | 17 | Fair | 3 | 3 | 0 | 0 | 3 | 2 | 0 | 3 | 0 | 3 |
Stecker et al., 2014 (22) | RCT | 19 | Fair | 3 | 3 | 0 | 0 | 2 | 2 | 2 | 3 | 1 | 3 |
Interrater Reliability
Discussion
Potential Biases and Limitations in the Review Process
Future Directions
Conclusions
Acknowledgments
References
Information & Authors
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Authors
Competing Interests
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