Engagement, Disengagement and Re-Engagement in Mental Health Services Among Young Patients With First-Episode Psychosis: A Scoping Review.

introductionEngagement in mental health services among young patients with first-episode psychosis (FEP) is crucial for preventing relapse. We conducted this scoping review to establish the proportion and determinants of engagement, disengagement and re-engagement in outpatient mental health care among young patients from 13 to 35 years with FEP.

methodsWe used the guidelines for scoping review by the Joanna Briggs Institute (JBI) and the Arksey and O'Malley framework. We searched for published and unpublished studies guided by the inclusion criteria: studies published in English from 1990, the expansion of psychiatric outpatient, focused on engaged, disengaged and re-engaged in outpatient mental health care using quantitative, qualitative and mixed methods studies. We performed the numerical and thematic analysis and reporting using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for scoping review (PRISMA-ScR).

resultsAbout 25 articles published from 2002 to 2020 met the inclusion criteria for this review; the proportion of young people with FEP who remained engaged was 45.5% for 6 months of follow-up, and the proportion of re-engagement after initial disengagement was 78.8%. Disengagement ranged between 13% and 56.3% for 12-36 months. The socio-demographic factors associated with disengagement were older age, male, black, unmarried status, living alone, unemployment, social and material deprivation, poverty, substance use and involvement with criminal justice. Some clinical determinants included a history of mental illness in the family and a psychosis disorder diagnosis other than schizophrenia.

conclusionDisengagement from mental health services is consistently high among people with FEP, indicating the need for intervention studies that address the associated individual and clinical factors to ensure their retention in treatment.