Engagement and early termination of contact with a community-based early intervention service for personality disorder in young adults

Abstract

Background: Few studies have examined factors associated with continuity of care in a community-based early intervention service for personality disorder in patients aged 16-25.

Aims: To estimate the probability of dropping out of care in patients attending an early intervention service for personality disorder and identify patient characteristics associated with those who drop out, are discharged or continue using the service.

Method: A 24-month cohort of first-contact patients attending the early intervention service was followed up for 12 months to identify drop-outs, discharges and those still using the service.

Results: One hundred eighty-three first contact patients were referred/self-referred during the study timescale. After 12-month follow-up, 83 (45%) were discharged, 39 (21%) still using the service and 61 (33%) dropped out. Drop out was most likely among patients aged 21-25, from higher socio-economic groups and highest during months 3-5 of service use. No discharges occurred until at least 3 months into the service, with a peak at 6-8 months.

Conclusions: Although sharing many factors predicting increased levels of drop-out, the rate of drop-out among young adults aged between 16-25 attending an early intervention service for personality disorder was equivalent to that experienced by services for adults with a long history of personality disorder diagnosis. Concerns exist, however, concerning increased rates of drop-out among patients reporting a greater number of difficulties, reporting a common mental health or substance abuse problem, and during months 3-5 of service use. Implications of the results for future service developments are discussed.