An evaluation of predictors of dropout from an Emotional Coping Skills programme in a community mental health service

Abstract

Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base. Key learning aims (1) To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature. (2) To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services. (3) To understand the potential impact of staff assumptions of factors that affect drop-out on client retention. (4) To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.