II. Noncompliance in psychiatric aftercare

The focus of the present study was to examine the extent of noncompliance in psychiatric aftercare in an integrated hospital and community mental health service. Characteristics of those patients who were noncompliant were explored in order to facilitate the prediction of treatment noncompliance at the point of discharge from hospital. A consecutive cohort of patients discharged from an acute psychiatric general hospital unit into an integrated community mental health service provided data regarding demography, disease state, attitude to treatment and actual treatment availed in aftercare. At six months follow-up 36% of the initial cohort of 128 patients had met the study criteria of noncompliance in psychiatric aftercare. A number of demographic and clinical criteria distinguished this group including the engagement in skilled employment and the presence of an anxiety rather than psychotic disorder. Noncompliant patients were less symptomatic with more disturbed behavior than those patients remaining in treatment. Noncompliant patients were significantly more likely to have a case manager of lesser experience, to have committed serious crimes and to have predicted their default from treatment at the time of discharge. Noncompliance in psychiatric aftercare persists (despite the availability of integrated hospital and community mental health services) raising the question of the goodness of fit between patient need and service provision.