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Effects of opt-in letters in a National Health Service psychotherapy service

  • Simon Houghton (a1), Dave Saxon (a1) (a2) and Amanda Smallwood (a1)
Abstract
Aims and method

Up to a third of clients referred to National Health Service (NHS) mental health services will miss their first appointment. Opt-in systems are widely used to reduce non-attendance but there has been little published research examining the effects of such methods on clients. A cohort study with non-randomised historical controls was used to examine the introduction of an opt-in letter as the route to a first appointment in an NHS psychotherapy service.

Results

The introduction of the opt-in letter slightly reduced non-attendance rates for first appointments, but this was at the expense of overall access to the service for the highest prevalence disorders.

Clinical implications

It appears that although an opt-in system can reduce non-attendance at first appointments, it may have an unintended consequence of denying access to clients with the most common mental health problems such as anxiety disorders and depression.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Simon Houghton (simon.houghton@shsc.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Hoare, P, Norton, B, Chisholm, D, Parry-Jones, W. An audit of 7000 successive child and adolescent psychiatry referrals in Scotland. Clin Child Psychol Psychiatry 1996; 1: 229–49.
2 Aubrey, R, Self, R, Halstead, JE. Early non-attendance and subsequent attrition from psychological help. Clin Psychol 2003; 32: 610.
3 Hawker, DSJ. Increasing initial attendance at mental health out-patient clinics: opt-in systems and other interventions. Psychiatr Bull 2007; 31: 179–82.
4 Care Services Improvement Partnership. Designing Primary Care Mental Health Services. Department of Health, 2006.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Effects of opt-in letters in a National Health Service psychotherapy service

  • Simon Houghton (a1), Dave Saxon (a1) (a2) and Amanda Smallwood (a1)
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