Dropout from outpatient mental health care: results from the Israel National Health Survey

  • Yaacov LernerEmail author
  • Daphna Levinson
Original Paper



To examine the dropout rates from outpatient mental health treatment in the general medical and mental health sectors and to identify the predictors of dropout.


The study population was extracted from the Israel National Health Survey. The analysis was related to 12-month service utilization for mental health reasons.


The total dropout rate from mental health treatment was 24%, but differed between sectors. The dropout rate from general medical care was 32, and 22% from mental health care. In the general medical care sector, 30% ended treatment within two visits, while only 10% did so in the mental health-care sector. Chronic health condition, but not severity of psychiatric disorder, predicted dropout in the mental health sector.


The higher rate of early dropout in general medical care may be related to the brevity of general medical visits and/or the inexperience of primary care physicians, which limits the opportunity to develop patient–physician rapport. Providers of services will have to promote education programs for GPs and allocate proper time to psychiatric patients.


The sample, although based on a national representative cohort, was small and limited the number of independent variables that could be examined.


Nonpsychotic mental disorders Mental health services General medical care Dropout 



The national health survey was funded by the Ministry of Health with additional support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The views and opinions expressed in this chapter are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, or of the Government. The Israel Health Survey was carried out in conjunction with the World Health Organization/World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centers for assistance with instrumentation, fieldwork and consultation on data analysis. These activities were supported by the National Institute of Mental Health (R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the U.S. Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Co., Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at


  1. 1.
    Baumeister H, Harter M (2007) Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol 42:537–546PubMedCrossRefGoogle Scholar
  2. 2.
    Codony M, Alonso J, Almansa J et al (2009) Perceived need for mental health care and service use among adults in Western Europe: results of the ESEMed Project. Psychiatr Serv 60:1051–1058PubMedCrossRefGoogle Scholar
  3. 3.
    Cuijpers P, Dekker J, Hollon SD, Andersson G (2009) Adding psychotherapy to pharmcotherapy in the treatment of depressive disorders in adults: a meta-analysis. J Clin Psychiatry 70(9):1219–1229PubMedCrossRefGoogle Scholar
  4. 4.
    Edlund MJ, Wang PS, Berglund PA et al (2002) Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry 159:845–851PubMedCrossRefGoogle Scholar
  5. 5.
    Goldfracht M, Shalit C, Peled O, Levin D (2007) Attitudes of Israeli primary care physicians towards mental health care. Int J Psychiatr Relat Sci 44:225–230Google Scholar
  6. 6.
    Graham LA, Julian J, Meadows G (2010) Improving responses to depression and related disorders: evaluation of a innovative, general, mental health care workers training program. Int J Mental Health Syst 4:25CrossRefGoogle Scholar
  7. 7.
    Kessler RC, Angermeyer M, Anthony JC et al (2007) Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Surveys. World Psychiatry 6:168–176PubMedGoogle Scholar
  8. 8.
    Kessler RC, Utsun TB, The World Mental health (2004) (WHO) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121PubMedCrossRefGoogle Scholar
  9. 9.
    Levinson D, Lerner Y (2009) Employment among persons with past and current mood and anxiety disorders in the Israel National Health Survey. Psychiatr Serv 60:655–662PubMedCrossRefGoogle Scholar
  10. 10.
    Levinson D, Lerner Y, Zilber N, Lahav I, Polakiewicz J (2008) “The Prevalence of Mental Disorders and Service Use in Israel: results from the National Health Survey, 2003–2004”. In: Kessled RC, Ustum TB (eds) In the WHO World Mental Health Surveys: Global perspectives on the Epidemiology of mental disorder. Cambridge University press, New York, pp 346–363Google Scholar
  11. 11.
    Levinson D, Lerner Y, Zilber N et al (2007) Twelve-month service utilization rates for mental health reasons: data from the Israel National Health Survey. Isr J Psychiatr 44:114–125Google Scholar
  12. 12.
    Levinson D, Paltiel M, Nir M, Makovki T (2007) The Israel National Health Survey: issues and methods. Isr J Psychitr 44:85–93Google Scholar
  13. 13.
    Levinson D, Zilber N, Lerner Y et al (2007) Prevalence of mood and anxiety disorders in the community: results from the Israel National Survey. Isr J Psychitr 44:94–103Google Scholar
  14. 14.
    Ministry of Health, Mental Health Services and Department of Information and Evaluation (2004) Statistics Annual 2004. Jerusalem: Ministry of health, Mental Health Services and Department of Information and Evaluation (In Hebrew)Google Scholar
  15. 15.
    Mojtabai R (2005) Trends in contact with mental health professionals and cost barriers to mental health care among adults with significant psychological distress in the United States: 1997–2002. Am J Public Health 95:2009–2014PubMedCrossRefGoogle Scholar
  16. 16.
    Mojtabai R, Olfson M, Mechanic D (2002) Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Arch Gen Psychiatry 59:77–84PubMedCrossRefGoogle Scholar
  17. 17.
    Olfson M, Mojtabai R, Sampson N et al (2009) Dropout from outpatient mental health care in the United States. Psychiatr Serv 60:898–907PubMedCrossRefGoogle Scholar
  18. 18.
    Research Triangle Institute (2003) SUDAAN Version 8.0.2. Research Triangle Park, Research Triangle InstituteGoogle Scholar
  19. 19.
    Sareen J, Jadgdeo A, Cox BJ et al (2007) Perceived barriers to mental health service utilization in the United States, Ontario and the Netherlands. Psychiatr Serv 58:357–364PubMedCrossRefGoogle Scholar
  20. 20.
    Simons AD, Levine JL, Lustman PJ et al (1984) Patient attrition in a comparative outcome study of depression: a follow-up report. J Affect Disord 6:163–173PubMedCrossRefGoogle Scholar
  21. 21.
    Tempier R, Meadows GN, Vasiliadis HM et al (2009) Mental disorders and mental health care in Canada and Australia: comparative epidemiological findings. Soc Psychiatyr Psychiatr Epidemiol 44:63–72CrossRefGoogle Scholar
  22. 22.
    Trepka C (1986) Attrition from an outpatient psychology clinic. Br J Med Psychol 59:181–186PubMedCrossRefGoogle Scholar
  23. 23.
    Van Schaik DJF, Klijin AFJ, van Hout HPJ, van Marwijk HWJ, Beekman ATF, Haan MDE, Van Dyck R (2004) Patients preferences in the treatment of depressive disorders primary care. Gen Hosp Psychiatry 60:184–189; 60:184–189Google Scholar
  24. 24.
    Van Voorhees BW, Fogel J, Houston TK et al (2006) Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Soc Psychiatyr Psychiatr Epidemiol 41:746–754CrossRefGoogle Scholar
  25. 25.
    Wang J (2007) Mental health treatment dropout and its correlates in a general population sample. Med Care 45:224–229PubMedCrossRefGoogle Scholar
  26. 26.
    Wang PS, Aguilar-Gaxiola S, Alonso J et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370:841–850PubMedCrossRefGoogle Scholar
  27. 27.
    Wang PS, Angermeyer M, Borges G et al (2007) Delay and failure in treatment seeking after first inset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6:177–185PubMedGoogle Scholar
  28. 28.
    Wells AB, Schoenbaum M, Unutzer J, Lagomasino IT, Rubenstein LV (1999) Quality care for primary care patients with depression in managed care. Arch Fam Med 8:529–536PubMedCrossRefGoogle Scholar
  29. 29.
    WHO World Mental Health Survey Consortium. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys (2004) JAMA 291:2581–2589Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Falk Institute For Mental Health StudiesKfar Shaul HospitalJerusalemIsrael
  2. 2.Mental Health Services, Ministry of HealthJerusalemIsrael

Personalised recommendations