Barriers to treatment: reasons for non-attendance in women's secure settings

Purpose - The aim of this paper is to investigate reasons for treatment non-attendance for dual diagnosis women in secure psychiatric settings.Design methodology approach - A semi structured interview was used to investigate patients' reasons for session non attendance on the day of non participation across four wards. Reasons for non attendance were grouped using the mulifactorial offender readiness model (MORM) categories of affective, volitional, behavioural, cognitive and external. Assignment of responses to categories was undertaken by a two person team and inter rater reliability was assessed.Findings - Patients' rates of attendance varied by ward and level of security (low vs medium); and diagnosis. Systematic enquiry about the reasons for non attendance led to increased session attendance. Reasons for non attendance were cognitive reflecting negative evaluations of treatment and treatment outcomes. Psychological therapies and educational sessions were deemed the most important along with one-to-one clinician appointments.Originality value - Issues of treatment engagement and the timing of treatment interventions are major issues in the care of secure psychiatric patients, particularly those with a primary diagnosis of personality disorder. Findings highlight the importance of systematic enquiry about reasons for non attendance and suggest potential interventions designed to improve engagement.