[Patients coming back after interruption of care in a community mental health center: Associations with care provision and psychopathological features].

A large number of people with mental health problems do not receive any treatment and in a large number of patients under care the treatment is interrupted. Non-compliance to treatment, observed in many different settings, is a major challenge in providing mental health care. The aim of the present study was to assess the demographic, social and psychological characteristics of the patients coming back for help to community psychiatric services and to shed some light to the reasons of interrupting and coming back. Special emphasis was placed on the possible correlation with specific mental disorders and whether or not the treatment was completed. The survey was carried out at the Byron- Kessariani University Mental Health Center, in a middle-classes catchment area and offering free of charge services. During the years from 2012 to 2016: 346 patients interrupting treatment (PIT) came back, while 1643 new patients were registered. The PIT were assessed with a specific questionnaire consisting of 34 open and closed-ended questions on changes in socio-demographic data, diagnosis, reported causes of discontinuation of care, services provided, important life events, follow-up by other mental health services after interruption of care, medication, and hospitalizations. The data were collected by trainee psychologists through a structured interview lasting 15-30 minutes and also from patients' medical records. Out of the 525 PIT during the study period, we excluded 148 who asked only for a certificate and 31 with many missing values. The final sample consisted of 346 patients and the analysis has focused on 299 PIT falling into one of the following four basic diagnostic categories: (a) schizophrenia and other psychotic disorders (12.7%), (b) mood disorders (41.3%), (c) neurotic and stress-related disorders (22.0%), (d) family and couple problems (10.4%). 64.1% of the PIT considered that they had not completed their previous treatment in the center, 19% attributed the interruption of care to reasons related to the center operation, and 88.4% considered that their demand had been satisfied. The highest rate of patients coming back was observed in the first year (31.7%) and then in four or more years (43.4%) after interruption of care. 32.7% discontinued the medication, 21,4% continued the medication following previous prescription. 47.3% had no follow-up, while 52.7% had been followed-up (36.6% of them by a private psychiatrist and 30.7% by a psychiatrist in a public institution). 45.5% of people with schizophrenia and other psychotic disorders were hospitalized in the meantime. The relationships between diagnosis and follow-up status with unemployment were tested but these associations were not statistically significant. There was greater satisfaction by those who completed treatment, as expected. Reasons for interruption related to the center operation, such as the work shift, the frequent changes in stuff members and the quality of care, are of particular importance.