.2. NONCOMPLIANCE IN PSYCHIATRIC AFTERCARE

The focus of the present study was to examine the extent of noncomplia nce in psychiatric aftercare in an integrated hospital and community m ental health service. Characteristics of those patients who were nonco mpliant were explored in order to facilitate the prediction of treatme nt noncompliance at the point of discharge from hospital. A consecutiv e cohort of patients discharged from an acute psychiatric general hosp ital unit into an integrated community mental health service provided data regarding demography, disease state, attitude to treatment and ac tual treatment availed in aftercare. At six months follow-up 36% of th e initial cohort of 128 patients had met the study criteria of noncomp liance in psychiatric aftercare. A number of demographic and clinical criteria distinguished this group including the engagement in skilled employment and the presence of an anxiety rather than psychotic disord er. Noncompliant patients were less symptomatic with more disturbed be havior than those patients remaining in treatment. Noncompliant patien ts were significantly more likely to have a case manager of lesser exp erience, to have committed serious crimes and to have predicted their default from treatment at the time of discharge. Noncompliance in psyc hiatric aftercare persists (despite the availability of integrated hos pital and community mental health services) raising the question of th e goodness of fit between patient need and service provision.