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The Open DoorHomelessness and Severe Mental Illness in the Era of Community Treatment$
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Carol L. M. Caton

Print publication date: 2017

Print ISBN-13: 9780190463380

Published to Oxford Scholarship Online: April 2017

DOI: 10.1093/acprof:oso/9780190463380.001.0001

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Overcoming the Problem of Disengagement from Treatment

Overcoming the Problem of Disengagement from Treatment

(p.55) Chapter 4 Overcoming the Problem of Disengagement from Treatment
The Open Door

Carol L. M. Caton

Oxford University Press

Advances in evidence-based mental health treatment have expanded opportunities for people with serious mental illness to avoid unnecessary suffering and disability so that they can establish satisfying lives in the community. Unfortunately, many fail to engage in treatment and are left behind. Disengagement, or dropping out of contact with the service system before recovery is complete, can lead to devastating consequences, such as a recurrence of symptoms, re-hospitalization, violent and self-destructive behaviour, substance abuse, and homelessness. This chapter deals with service gaps that reduce access to treatment, reasons for disengagement, characteristics of people who refuse treatment, and approaches to service engagement such as leveraged housing and treatment, involuntary inpatient treatment, assisted outpatient treatment, and shared decision making. The state of the science on voluntary and involuntary treatment is reviewed, with recommendation for further research.

Keywords:   Treatment disengagement, reasons for disengagement, characteristics of dropouts, leveraged housing, involuntary hospitalization, assisted outpatient treatment, shared decision making

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