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Attrition rate in mental health clinics in Israel and comparison of
dropouts and continuers
Iulian Iancu, Ehud Bodner, Igor Kalman, Ana Piccone Sapir, Neil Laufer, Itzhak
Ben-Zion, Moshe Kotler, The Beer Yaakov Hospital, Israel.
Background: Attrition from mental health clinics is a frequent
problem with significant consequences for patients, families and
society. We examined the rates of attrition from 5 mental health
clinics in Israel and the reasons for attrition from the perspective of
the dropouts.
Methods: 179 dropouts and 171 patients who continued treatment
completed questionnaires on socio-demographic and clinical data,
attitudes to treatment and barriers, self-stigma and health. The
dropouts provided their reasons for dropping out.
. Reason for disengagement
Results: We found very high attrition rates
in all clinics. Attrition ranged from 41.5%
(clinic B) to 83% (Clinic E), with rates of 78.5
in clinic A, 72% in clinic C and 70% in clinic
D.
The main reasons for attrition from the
perspective of the dropouts were as follows:
no need of treatment, poor/unhelpful
treatment and problems with medications.
Two predictors of attrition were found:
patients' report that the treatment approach
was not appropriate for them and previous
compliance problems. Dropouts reported
worse condition and were less in treatment,
as compared to continuers. Nevertheless,
many dropouts improved and had undergone
empowerment and felt gratitude towards
the system.
This study was financed by Israel National Institute for
Health Policy Research.
Number (%)
No need for treatment
42 (23.5%)
Bad or unhelpful treatment
26 (14.5%)
Bad medications or side effects
11 (6.1%)
Need to work/study or unsuitable hours
9 (5%)
Chose a different treatment program
8 (4.4%)
Did not receive psychotherapy treatment
7 (3.9%)
or psychotherapy treatment was stopped
Disease itself
5 (2.8%)
Other reasons
23 (12.8%)
Causeless/ do not remember/ did not give 48 (26.8%)
a reason
Conclusions: Attrition is frequent in
psychiatric clinics, but can be predicted.
Attention is needed regarding the
negative consequences of attrition and
searching for ways to decrease the
phenomenon is warranted.
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