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Barriers to attending initial psychological therapy service appointments for common mental health problems: A mixed-methods systematic review

Jenny Sweetman, Research Associate in the University of York's Department of Health Sciences, discusses her mixed-methods systematic review looking at why some pople do not attend their initial psychological therapy appointments.          


Common mental health problems like depression and anxiety affect many people. There are services which offer psychological treatments (talking therapies) which can be helpful for people with common mental health problems. Unfortunately, many people donít attend the first couple of appointments at these services, so they donít actually get any support.

These missed appointments also mean that waiting times for other people get longer. We wanted to find out what caused people to not attend the first couple of appointments at these services. 



We completed a systematic review of published research articles which concentrated on why people had not attended one of the first couple of appointments offered by primary care mental health services.  This was a mixed-methods review because it included information from research articles which collected different types of data, such as observational and interview data.



We searched for research articles in five online healthcare databases: MEDLINE, CINAHL, EMBASE, Cochrane Library and PsycINFO.  Articles were included if they focussed on people aged 16 or over with a common mental health problem (such as depression or anxiety).  Research articles which described psychological treatments, and specifically focussed on non-attendance to the first two appointments were included. 

We did not include research articles which only reported on the social or demographic characteristics of people who had not attended one of the first two appointments for psychological therapies.  Information from studies reporting observational data were analysed separately to information from interview studies.  These two analyses were then compared.



34 articles were included in this review; 24 reported observational information and 9 reported information from interview studies.  One article included both observational and interview data.  There is evidence that primary care mental health teams need to consider how treatments are being offered to people who are referred. 

Findings indicated that the treatments offered should match people's perceptions of their mental health problem to ensure that appointment attendance is considered relevant.  Making efforts to identify and reduce concerns people may have about attending appointments and offering prompt responses to referrals with the flexibility to accommodate an individual's circumstances were consistently highlighted as important. 

People seeking support for mental health problems were concerned about how others in their social network would view them if they attended; more work is needed to improve perceptions of mental health services in the community.


What's Next?

This is the first of three phases in an Economic and Social Research Council (ESRC) funded PhD aiming to increase our understanding about the barriers faced by people who would like support for common mental health problems in England. 

The second phase of this work involves a statistical analysis of referral data collected by five IAPT services. 

The final phase describes an interview study exploring the experiences of GPs, IAPT professionals and people who were referred to IAPT services but did not attend one of the first two appointments offered.

You can read the full published article online here.


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