Mental health is a serious issue that affects millions of Americans. More than 43 million American adults (18 percent of the adult population) struggle with mental health and substance abuse conditions. Yet 56 percent of adults with a mental illness do not receive treatments, while one in five adults with a mental health condition reports an unmet need.
Issues like stigma and lack of access stop many people from getting the psychotherapy they need. A big part of the battle is getting people into the office, but the work doesn’t end there. Mental health professionals also have to think about patient retention.
Retention refers to the number of patients who return for treatment. Patient dropout, also known as attrition, is the opposite of retention. One study of mental health treatment patient retention found that approximately 35 percent of patients stopped their therapy after just one session, while approximately 50 percent of patients stopped their treatment by their third session. While it’s possible that some patients who discontinue mental health therapy no longer need treatment, patient attrition is likely related to something else. Other research suggests that approximately 20 percent of patients leave therapy too early.
Learn why patients decide to discontinue psychotherapy, how to improve therapy patient retention and what happens when patients drop out from psychotherapy.
Reasons That Patients Leave
Patient retention rates in behavioral health can be affected by many different factors. Understanding what those reasons are can help mental health professionals and their practices address them and improve patient retention. Here are four common reasons people decide to stop psychotherapy.
1. The Patient and Therapist Are Not the Right Fit
A lot of people hold off on getting psychotherapy because they worry about sharing private thoughts and feelings with a stranger. If they do not feel comfortable with their therapist, it’s unlikely they will return for another session. Obvious reasons for patient discomfort include unethical behavior, poor listening skills, lack of engagement with their questions or a therapist’s lack of experience with their particular issues.
Naturally, unethical behavior, inability to listen and lack of engagement are major issues that need to be addressed immediately. If you find you lack experience with a particular issue, say family trauma, do not ignore that. Instead, offer to refer the patient to a colleague with direct experience in that situation if possible.
Of course, it’s possible that none of those reasons are behind your patient’s decision to leave. It could simply be a matter of personality mismatch. A patient just might not be comfortable opening up to you. Don’t take this personally. Instead, make it clear to the patient that it’s perfectly acceptable. You can also think about ways to create a more comfortable atmosphere for future patients. For example, you can make an effort to find out about a patient’s value system and provide advice and care within that system.
2. The Patient Underestimates the Required Commitment
Many patients do not know what to expect before they begin psychotherapy, or they might have an incorrect, preconceived notion. Mental health treatment takes a commitment from patients. They need to not only show up to their appointments but also actively work to change behavior patterns and take prescribed medication.
Changing lifelong habits and/or waiting for a medication protocol to work takes time. Some patients may have thought that therapy would be a “quick fix” that wouldn’t require any work outside of the office. When they find out differently, they might stop attending therapy.
Do not assume that a patient knows what kind of work they’ll need to put into therapy. Set expectations upfront, and be prepared to answer questions. If the patient expresses hesitancy, try to find a way to break the commitment to therapy down into smaller, more manageable goals.
3. Scheduling and Wait Time Are Not Patient-Friendly
Some patients may have reasons for leaving a psychotherapy practice that have nothing to do with their therapist or their expectations. Scheduling and wait times are a common cause of attrition that affects all different types of medical specialties.
Of course, you have a busy practice, but your patients also have busy lives. They likely do not want to spend a lot of their time setting up an appointment and waiting to see you. If a patient has a difficult time getting ahold of your front office — being sent to voicemail, not receiving return phone calls and similar issues included — they may stop coming.
Likewise, if they know they’ll need to spend an excessive amount of time waiting in the office before their therapy session even begins, they’ll likely stop coming or find another practice.
4. The Patient Has Financial Concerns
No one should have to forego essential healthcare because of financial concerns, but, unfortunately, many people live with that reality. Health insurance premiums are rising, as well as deductibles and copays. If a patient has to choose between a therapy session or paying the bills, they may not be able to continue their care. Of course, you’re running a business, so offering free services is not sustainable. Instead, you can explore options like CareCredit, which helps patients manage out-of-pocket healthcare expenses, or find a way to start a charity care program.
Tips for Improving Psychotherapy Patient Retention
No-shows happen, but psychotherapy professionals and their offices can take several actions to dramatically reduce that number, which will help both the practice and the patients. Here are six different ways to improve psychotherapy patient retention rates.
1. Consider Patient Selection Strategies
Patient selection is not about turning away patients in need. Instead, it’s about creating screening protocols that will help determine if a potential patient and a therapist are a good fit. Screening protocols can help determine a patient’s history of trauma, substance abuse and/or mental illness. Even basic details can help therapists decide whether they’re a good fit for the patient.
If they aren’t a good match, the therapist can refer the patient to another professional who could provide more fitting care. If the screening protocols indicate a patient may struggle with committing to therapy, consider finding a way to better prepare them for treatment. This way, you can avoid some patient attrition that’s due to poor patient and therapist pairings.
2. Improve Scheduling Practices
Scheduling may seem like a small matter, but working on it is one of the most helpful tips for improving psychotherapy patient retention. When evaluating patient retention, take a look at your office’s scheduling practices. How do patients schedule appointments? Do they need to call? Are phone calls returned promptly? Can individuals make an appointment using an online portal? Does your office confirm patient appointments with a phone call, email or text?
Having a responsive front office staff and offering different options are simple ways to increase patient convenience, which increases the chance that patients will schedule follow-ups. Your practice’s office hours are another scheduling consideration. Many people have a strict nine to five, Monday through Friday work schedule. If your office hours never extend to the weekends or evenings, many patients may not be able to schedule appointments. Consider offering more flexible hours when you can.
Lastly, you’ll need to consider wait times. Are you so overbooked that patients are waiting 30 minutes or more before their appointment? If so, you may want to find ways improve scheduling. Time is precious, and people will stop coming if they feel theirs is being wasted.
3. Train Your Staff
Your staff members are usually the first point of contact between your office and any patient, which means they need to be courteous, efficient and empathetic. A single rude staff member can be enough to drive a patient away. Work with your staff to find ways to improve customer service, emphasize the importance of respect and help your team find ways to effectively communicate with patients. Coming to therapy can be a difficult decision. Patients want to feel comfortable with the people handling this sensitive situation.
4. Educate Patients
Not every patient knows what to expect when it comes to therapy. They might expect it to be easy, or they might think it won’t even help them. When you sit down with a patient, dedicate some time to educating them about the process. Explain your methods, set reasonable expectations for progress and answer any questions they have candidly.
An educated patient is less likely to drift away from therapy because they know what to expect and they know you’re available to answer their questions about the process. You can also provide educational resources on your website. Post informative blogs that patients can read before they even make their first appointment.
5. Find Ways to Individualize Care
Medical professionals know that every patient is different, and that’s particularly important to remember in psychotherapy. One approach may work for a certain patient but drive another away. Approach each new case with a fresh pair of eyes, and attempt to build your therapy approach based on the person.
This kind of individualized attention can go a long way toward reducing patient attrition. A psychotherapy patient who feels like you’re listening to their issues and feedback is much more likely to return than one who feels like you’re trying to make them fit your therapy approach rather than then the other way around.
6. Follow Up With Patients
When a patient misses a therapy session, it can be easy to let them slip through the cracks. Rather than writing them off, follow up with a quick message or phone call. Ask why the appointment was missed, and see if you can do anything about it.
Following up with all of your patients is a great general rule of thumb. A simple phone call from your office the day after a session can demonstrate how proactive and invested in the patient’s progress you are. It also keeps your practice front and center in the patient’s mind. Patients are more likely to stick with an office that stays in regular contact.
What Happens When a Patient Leaves Therapy?
Sometimes, a patient has gotten all they need from psychotherapy, and they’re ready to stop scheduling sessions. That’s a great thing, and you can feel proud that you helped the patient with their issues. However, if patients leave psychotherapy prematurely, it may not have a positive outcome for them or your practice. They could:
- Go to another practice: A patient might leave your practice and go to another. This situation could be caused by patient and therapist mismatch, scheduling conflicts, insurance issues or dissatisfaction with the office staff. If a patient does decide to go to another practice, try to find out if any of these are the reason and if not, why they chose to do so. This feedback could help you prevent the loss of future patients to competing practices.
- Struggle with the same behaviors that initially led them to therapy: If a patient leaves therapy prematurely and does not go to another practice, it’s likely they will continue to struggle with the same behaviors and problems that led them to therapy in the first place. They may have left because they weren’t prepared for the commitment therapy required. If so, they may avoid returning to therapy at a later date too. If you feel a patient is in danger of abandoning therapy too early, do your best to engage them, and find a way to continue positive treatment.
Finding the Right Patient Retention Tools
Mental health clinicians have a lot on their plates. They strive to provide their patients with effective, individualized care, but they still need to think about patient attrition. Certain tools, like software specifically designed for behavioral health, can help practitioners maintain their practice, support their patients and improve retention rates. When considering what type of behavioral health software to choose, look for features like:
- Scheduling: Scheduling is a crucial front office function. A paper system or simple calendar can be prone to errors. With behavioral health software, your office can schedule, track and manage all appointments in a single, intuitive system. See available times, patient cancellations, no-shows and scheduled appointments all in one convenient place.
- Appointment reminders: Patients have busy schedules. Simple appointment reminders can be an effective tool for reducing last-minute cancellations or patient no-shows. Behavioral health EHR software can send patients appointment reminders through a patient portal or text a reminder right to their phone. This simple function can save office staff time they would have spent on phone call reminders and help eliminate issues like overbooking.
- A patient portal: A patient portal is a great communication tool for patients. They can access their medical history, communicate with their therapist and schedule appointments through the secure portal. Open lines of communication are a core patient retention strategy.
- Progress notes: A progress notes feature can help clinicians accurately capture information about patients during the selection and treatment processes. This type of intuitive feature will help clinicians organize and manage patient evaluations, treatment plans and discharge instructions. This tool can be key in creating individualized patient care plans
Contact ICANotes to learn more or request a free trial of our behavioral health EHR software. We’ll work with your practice to come up with the most clinically robust and intuitive charting solution for your practice.
Clinical Director October has been a Registered Nurse for over 15 years. She is board certified in Mental Health and Psychiatric Nursing. She holds a Bachelor of Arts from the University of North Carolina at Greensboro. She also graduated with bachelor and master degrees in Nursing from Western Governors University.