Dropout rates in mental health centers

Judith Lorber, Ph.D., and Roberta Satow, Ph.D., are Assistant Professors of Sociology, Brooklyn College, The City University of New York, Brook lyn, New York. The article was read at the annual meeting of the Society for the Study of Social Problems in Montreal, Canada, in August 1974. Since the blossoming of the comview the therapist as a magician and munity mental health movement, there not understand their own part in the has been a proliferation of literature process. Along these lines, Lennard discussing the problems of community and Bernstein argue that the failure mental health centers and evaluating to sufficiently socialize lower-class pa their performance.1 A major area of tients to their roles as patients, which discussion has been the so-called dropwould enable them to function ade out rate. Underlying such discussions quately within the definitions provided has been the ,assumption that treatby the therapists, accounts for the high ment was going on, that there was dropout rates in clinics.8 Lorion, how some agreement between the patient ever, suggests that the responsibility and therapist about undertaking the rests with the professionals, who must treatment, and that the patient, at maximize the probability that the pa some point, unilaterally decided to tient will use the services.9 abandon the treatment and "dropped Freedman points out that there is out." The concept "dropout" is thus esa relationship between the duration of sentially the professional's judgment the therapy and the degree of congru that the patient quit the therapy before ence in the therapist's and patient's the treatment was complete. expectations, and Jacobs and his co in attempting to identify the reason authors suggest the usefulness of an for the high dropout rate among educational briefing to prepare lower lower-class patients, many researchers class patients for treatment and re have pointed to the difficulties involved duce the social distance felt by the in the middle-class professional's treatpsychiatric residents who will treat ing a lower-class client. There are them.10 One possible solution to the problems with communication 2 and problem of social distance is to recruit conflicts between value orientations.3 therapists from the same racial, eth Wilkinson suggests that lower-class nic, and social class backgrounds as "audiences" are more likely to tolerate the lower-class patients or to use in mildly disruptive behavior, so that digenous nonprofessionals.11 However, lower-class clients who do come to a even if such recruitment is effective, therapist's attention are more likely the common result is a reactivation of to be highly disruptive than middlesocial distance as lower-class and mi class or upper-class clients.4 Similarly, nority group therapists, professional Kline and King argue that dropouts or paraprofessional, become person are more impaired psychologically ally and occupationally upwardly mo and more likely to act out than conbile.12 tinuers and, hence, that their anger The present authors think that the and antisocial behavior may lead to whole question of evaluating services their being "eased out."5 Lerner and according to patient dropout rates Fiske claim that therapists' expectaneeds rethinking. The concept dropout tions of clients become self-fulfilling assumes that patients who do not come prophecies in that middle-class profesback to the facility after a few visits sionals tend to give poor prognoses are dissatisfied with the services they to patients who have characteristics have received, discouraged by the that are quite common in the lower therapists, or have misconceived what class, such as somatic complaints, extherapy is all about. However, one ternalization of blame, and low introstudy suggested that there is a small, spectiveness.® self-selected group of people who Myers and Schaffer suggest that make repeated use of the mental rules are a problem—that is, that health services available.13 If these lower-class patients are less likely to clients do drop out of treatment with come to sessions on time, use the out the consent of the therapist, they couch, or generally know what is extend to show up again at a later date, pected of them in the role of patient.7 either at the original facility or at In addition, the perception of the theranother, similar community facility, apist's role may be different among A larger group comes to the facility lower-class clients in that they may for one or two visits, perhaps under