Reasons for non‐attendance in youth mental health clinics: Insights from mobile messaging communications

Abstract

AimNon‐attendance at appointments in youth mental health services is a common problem which contributes to reduced service effectiveness and unmet needs. Reasons cited by young people for non‐attendance are poorly understood. Information derived from short‐message‐service (SMS) conversations about appointments between patients and clinicians can uncover new insights about the circumstances leading to ‘did not attend’ events.MethodsText messages between young people and clinicians were examined in a retrospective audit of medical records in two youth mental health services in Perth, Australia. Frequently non‐attending young people aged 16–24 (n = 40) engaged in 302 SMS message chains about appointments. Mixed methods included quantitative data and qualitative thematic analysis of textual data.ResultsMedical reasons (32/190, 16.8%) and forgetfulness (20/190, 10.5%) were the most frequent reasons for non‐attendance. Major issues included non‐avoidable events while others were potentially preventable and could be addressed by the service.ConclusionsThe analysis of mobile communications in clinical practice can be used for service evaluation and to reveal barriers that impede attendance to ongoing care.

Understanding the causes of missingness in primary care: a realist review

“…Patients experiencing missingness may be positioned in precarious socioeconomic circumstances that expose them to disruptive forces that threaten health, material and social wellbeing [ 9 , 11 , 17 – 19 , 43 , 49 , 59 , 62 , 65 , 71 , 96 , 103 ]. Ideas of competing demands or “conflicting candidacies”([ 79 ], p.56) shows how multiple urgent and competing priorities might result in reduced prioritisation of health or appointment attendance relative to other needs [ 30 , 32 , 36 , 40 , 50 , 55 , 57 , 59 , 62 , 82 , 83 , 99 , 102 , 103 , 107 , 121 – 128 ].…”

“…By virtue of socioeconomic position, patients may have reduced access to the flexible resources to protect them against these forces, while experiencing multiple pressures on the personal, material and social resources they do have access to [ 77 ]. These demands include treatment burden and other appointments [ 4 , 10 , 11 , 15 , 17 , 19 , 28 , 41 , 43 , 44 , 48 , 59 , 61 , 62 , 64 , 73 , 83 , 84 , 86 , 93 , 100 , 128 – 135 ]; employment responsibilities, employer inflexibility and the financial costs of missing work [ 11 , 40 , 44 , 46 – 49 , 59 , 64 , 81 , 106 , 107 , 109 , 115 , 123 , 135 – 137 ]; and caring responsibilities taking precedence [ 14 , 40 , 41 , 44 , 48 , 59 , 64 , 99 , 131 , 138 ]. Patients experiencing severe and multiple disadvantages may have to prioritise accommodation, physical safety and survival demands over healthcare [ 43 , 48 , 53 , 64 , 65 , 69 , 71 , 81 , 96 , 103 , 114 , 139...…”

“…Disabilities or severe physical or mental health symptoms can make travelling to appointments unsafe or unmanageable [ 8 , 9 , 13 , 15 , 30 – 32 , 36 , 40 , 41 , 44 – 50 , 54 , 55 , 58 , 60 – 62 , 64 , 65 , 68 , 82 , 84 , 86 , 89 , 90 , 96 , 99 , 100 , 103 , 105 – 110 , 122 , 125 , 126 , 128 , 129 , 133 , 141 – 150 ]. Social connections and their resources may be beneficial but are not always available to help [ 11 , 44 , 45 , 48 , 49 , 62 , 63 , 65 , 101 , 103 , 112 , 122 , 126 , 130 , 134 ]. Evidence synthesis Sects.…”

“…If services do not offer a timely appointment, patient circumstances change—they may forget, symptoms resolve, motivations change or other demands emerge, accounting for the almost universal finding that delays lead to missed appointments [ 18 , 27 – 32 , 39 , 40 , 51 , 69 , 90 , 91 , 96 , 119 , 152 ] [ 9 – 11 , 18 , 19 , 27 , 35 , 37 , 40 , 46 , 50 , 51 , 69 , 82 , 100 , 101 , 103 , 109 , 118 , 122 , 137 , 138 , 153 , 154 ]. If services do not offer a convenient time, patients may not be able to reconcile attendance with competing demands or with the rhythms and patterns of their lives [ 9 , 11 , 29 , 32 , 37 , 40 – 42 , 46 , 47 , 49 – 51 , 61 , 66 , 83 , 87 , 96 , 100 , 101 , 106 , 109 , 111 , 113 – 115 , 123 , 128 , 131 , 135 , 155 ]. If the system does not permit or support patie...…”

“…This was discussed by our Stakeholder Advisory Group, who felt that many patients are not attended to by services, and by literature suggesting that services, not patients, are “hard to reach” [ 41 , 48 , 71 ]. Other definitional challenges included the lack of shared definition of missed appointments—some studies include short-notice cancellations or lateness, while others do not—and of a shared definition of missingness, making comparability or generalisability harder [ 8 – 14 , 46 , 49 , 72 ]. Others question whether missingness even exists as a meaningful category for study [ 40 , 73 ].…”