Increasing initial attendance at mental health out-patient clinics: opt-in systems and other interventions

Out-patient appointments which are missed without prior notice are a major contributor to wasted resources in planned mental healthcare services. It is not unusual that a quarter to a third of patients referred to a service will miss their first appointment (Hoare et al , 1996). Non-attendance rates for second and subsequent appointments are lower. Early non-attendance predicts attrition later in treatment (Goode, 1997; Aubrey et al , 2003), leading to further wasted resources, with most first-time non-attenders never attending subsequent appointments.