In the profession of Clinical Psychology there can be several issues that may be present. Some of these issues can be in regards to patients, treatments, and termination. There is one issue that can be an escalating problem for not only the Psychologist but for patients as well. “The one issue that needs addressed would be appointments” . Appointments have big impact in the day and the life of a Clinical Psychologist.
Appointments are scheduled in advance with good faith that the patients will keep these appointments. The appointments keeps the Psychologists working, assisting people, and getting paid. The patients who have appointments need them for a reason. A patient or client of a Clinical Psychologist may need to be seen for a variety of different reasons. Many of those reasons involve mental health. When a mental health patient does not come back to their appointments it can harm both parties. The missed appointments are not only hurting the Psychologist, but the patients as well.
“Patients who do not show up for appointments, and do not reschedule there appointments could be a critical issue” . The people will set up a first appointment because they need help regarding the issue they are facing. The patient will be determined what kind of treatment is needed, and to what extent. If that person does not continue coming to appointments then that individual will be left in society without the help that is needed. If there are many people who don’t bother showing up to appointments; then they are added to this helpless situation.
The Clinical Psychologist will be affected by the no show appointments as well. A Clinical Psychologist sees many different patients in day, and has more patients on a waiting list to get seen. The Psychologist has a schedule to keep by the appointments set for the patients. When a patient does not show up, or call to cancel the appointment then the Psychologist has an empty slot and no patient. If the patient would have called to reschedule, or canceled the appointment ahead of time then the slot may have gotten filled by another individual. The Psychologist may have an hour of time to fill while waiting on the next patient to show up for their appointment. If the next patient does not show up or cancel appointment then the Psychologist would have another hour of time that could have been filled. The Psychologist is not going to get paid because the clients did not show up, and the slot was unable to get filled.
Psychologists cannot help someone if they do not show up for their appointment. The appointment the patient missed may have been an extremely important. The Psychiatrist will have to try and get ahold of the patient to find out why he did not show up or call. When a patient misses his appointment; then he cannot get his medication filled. “The patient could become unstable without the medication, and could possibly put himself and others in danger” .
Many Clinical Psychology offices are state, local, or federal funded. The funding that is determined for the clinic will often relate to patients that are being seen. The clinic may need to turn in the number of patients scheduled for the year. The no show patients will lower the total of patients seen for the year. If those same patients keep missing and not canceling their appointments then those will leave many empty slots for the year report. The missed appointments will decrease the money that the clinic could receive for programs, and supplies to keep the place running, and up to date on treatment resources. If the Clinical Psychologist does not get the money needed for treatment programs, some programs that are resourceful will have to close. The impact escalates into a negative downward spiral for everyone involved in the appointment process.
The appointments are the path to help and stability within Clinical Psychology. “In some Psychology offices there is a maximum number of times a person cannot show up for their appointment without calling to reschedule or cancel” . Once this happens the patients will need to start over. The patient will need to participate in the intake process, and work on getting back where they left off. The patient making very little progress because he now has to start over. This can be time consuming for the Psychologist and the patient. The patient may not want to do this and leave for good.
The patient will then either go somewhere else and start over and go through the intake process, or they won’t get help at all. Clinical Psychologists do not want this kind of pattern to happen. In a reality setting it does happen every day. There is many more patients that can be put into appointments who are waiting, but that does not save the people who left and did not return. The position of being able to help people is what it is all about. There are some people who are not willing to let you help them.
The no show appointments can effect crime and law enforcement. A patient who does not come in for their appointment to receive their medication can have impact on crime. If a person is not on medication that makes them mentally stable; they may commit crimes, and have interactions with law enforcement. The law enforcement would either have to obtain him, or send him for a mental evaluation. This scenario could happen in the result of a no show appointment. The individuals who are not taking their medication and cause problems in the community should have went to their appointment. If the person would have showed up; they would be on their medication, and not getting into trouble with the police.
Another impact a mental health patient missing an appointment would affect their family, and EMT services. If a person suffering from mental health issues, and is acting unstable they may try to harm themselves. If they do not harm themselves then they could get destructive, violent, or hurt someone else. When these situations occur it is not uncommon for the E.M.T. and police to show up to assist in the unstable situation. If this person had taken their medication they may never have acted out in a manner that would involve violence, and instability behavior.
The individual who had not been coming to participate in appointments; could have harmed or caused fear in family, friends, or loved ones. A person off his medication could lash out, get verbally aggressive, violent, bullying, and act in uncontrollable manner. The family may get hurt or scared of the person who was unstable because of their actions. The family may have to repair damages caused by the behavior the individual. Which was caused by not going to appointment and getting the prescription for medication. The impact of this type of behavior can be escalated, and directed towards a number of people and situations. The person may not even remember what happened once he is stabilized.
The missed appointment will cause the client not to be well, and can cause further issues. The well-being of the client is important not only for himself, and for everyone around him. “There is more mental health patients who do not come to their appointments; than there is in other medical fields” . This number should not be higher in regards to individuals with mental health. These people need their appointments, and risks can be a factor if they do not show up for them.
The consequences of not keeping up with appointments in regards to mental health can be tragic. Many incidents that authorities respond to are in regards to mental health and going off medication. The effects that this causes are; financial expenses, and time. If the authorities did not have the multiple mental health responses to attend to; then they could be apprehending criminals. It takes funding for transport of patient when authorities are called. It cost for treatment and stabilization to assist. There are many financial concerns when appointments are missed by mental health individuals
The patients who miss and do not reschedule appointments could be court ordered, or in a benefit assistance program. If the person misses these appointment then he is not upholding the court order or the state benefit program qualification. The courts and state program will now have to track down the patient, and find out why he is not going to appointments. If it is court ordered; the patient may then have consequences of the court, or be placed in an in house facility. .If the person is coming to the Clinical Psychologist based on benefit program assessment then the patient could risk being kicked off the program and losing the benefits he receives.
This negative process leads to court having to spend more money in regards to the patient. The state will be spending more money for benefit workers who are looking into that persons’ case. The patient would not only be hurting himself, but be wasting time, and money that could be used for many other purposes. All the client would have needed to do; was come in to the appointment, or rescheduled it. Instead of going through this type of negative impact in his life. When these types of issues occur it can also cause physical health problems. If the mental health of a person is not stable; then his eating habits, and other behaviors will be unstable as well. The impacts are never ending and need to be addressed in a different manner.
There is a difference between a patient who may not show or call for a couple appointments a year, and those who don’t show most of the year. The patients who few appointments; are not as at risk for these situations to occur. The patients who just do not come back or do so after months of non-treatment or medication is a problem. The individuals who do not show at all; are very susceptible for disaster, and relapsing into other concerns of illness. Patients who do not take their medication and quit the appointments are more likely to dabble with drugs and alcohol. The mix of drugs or alcohol in regards to mental instability can be a volcano ready to irrupt.
There needs to be a way for Clinical Psychologists to help these people to keep appointments. If something is not done to reduce or prevent this from happening soon; then the future could be problematic for the Psychologist and the patients. There are different scenarios that could be keeping the patient from showing up or calling to cancel. Some people just don’t do it became they do not want to or do not care. There are some people who live in rural areas, and do not have reliable transportation to get to the appointments. A family member or caregiver may not be getting the patient on time, but the patient is still held reliable for an appointment that was not canceled or rescheduled.
Research needs to be done to find out why mental health patients are not keeping their appointments. Some of the reasons may stem from transportation issues, forgot appointment, no reason, or other reasons could apply. A person may be having competency issues and is not coming to appointments; because he is not understanding that process as an important factor for his well-being. If a clinic finds that patients are having trouble finding a ride to their appointments then other resources should be an option for these people.
One option would be to try to schedule one or two days a week for rural patients who do not have rides. Have the clinic fund a van or bus to go and pick these people up for one or two days a week for these appointments. The appointments can be scheduled for only a couple of days a week and therefore this would not be as expensive to pick up the patients. If school buses can drive out to rural areas twice a day to pick up and drop off kids; then why can this not be done to pick up mental health patients and take them to their appointments. The transportation could run once of a morning, and around noon, and then at the end of the day to pick up or drop off patients. This would help in getting the people with no transportation or unreliable transportation to their appointments on time.
Another option for people who lose their appointment cards, and change their phone numbers a lot may not know they have appointments. People’s lives can be hectic, and remembering an appointments that are scheduled can be hard to do. We get sidetracked, and engulfed in our own life drama that sometimes makes it is easy to forget. For those people who forget to show up for every appointment, and forget to call for every appointment have a different problem. There needs to be an easier way for appointments to be reminded instead of calling and leaving a voicemail.
When patients are reminded the day before they have an appointment then they are more likely to either show up, or ask to reschedule. The catch is getting someone to answer for this conversation to happen. With technology as advanced as it is there should be a way to keep up to date with communication and connecting with patients, and clients.
If each clinic could have an app made that people can download, register, or accept updated information for their appointments and other useful information then this may work for reminding people. A person may screen their phone calls and miss the appointment reminder. The same patient might not ever check voicemails. This same person who does not answer the phone, but may be on an app for Facebook, or Twitter. If the app could be designed to remind people via chat, or message then they may come to their appointments or call to reschedule. The app would be a qualification for the clients to have for interaction between clinic and patient.
This will allow the patient to see a notification, and can respond that he is coming or needs to reschedule. There may be a decrease in no shows, and missed appointment for clients with mental health. The app could even be designed for the patient to set reminders for medication, and other handy features. The app and transportation will not be able to save everyone and get them to keep appointments. If it would help half of the patients show up for appointments then this would be a positive success for everyone involved in the Clinical Psychologist process.
There is another option for patients with severe mental illness who does not take mediation, and does not show up for appointments. A patient is causing problems in society, not taking prescription, not coming to appointments, and is extremely mentally unstable. This person could benefit better for a program that was more in house based. This type of treatment depends on the situation of each patient. This type of treatment would not be for every patient, but only for those who would benefit and qualify for it.
An in house treatment program would benefit those who need their medication, but also need assistance with other issues as well. An in house facility would ensure the patient is getting the treatment, help, and resources that he needs because he is there, and not leaving. The programs length could vary depending on the situation, issue, and patient’s needs. In house treatment would not be the same as a mental institution. It would be a place that is safe, and secure for patients. The program can include therapy, substance abuse while treating mental illness, depression, and suicidal tendencies to ensure other patients could get adequate help.
Clinical Psychologists would benefit as much as the patients if appointments were kept. Patients are hurting themselves and the programs that are involved to make the clinics operable. Menial health is a big factor in many people in today’s society. It is important for people to get the help they need to have a productive, and normal life. People who suffer from these types of illnesses struggle with normal life, and life patterns. It is difficult for someone who has these extensive issues to preform without proper treatment and medication. If Clinical Psychologist could get better control of patients keeping their appointments then the process for everyone would go better and smoother. It is important to find what will fix the issue, and act on it. The sooner patient’s start keeping appointments; the better the treatment outcome and process will become.
Reference
Benhke, S. (2009). Termination and Abandonment. American Psychology Association, 1-8.
Coklin, C. (2010). Appointment No Show. Psychology Reports, 1-5.
Martin, K. (2015). The Challenge of Patient Adherence. National Institute of Health, 1-10.
Matthews, J. (2016). Appointments. Counseling and Psychological Services, 1-3.
Mitchell, A. (2015). Why Don't Patients A. BJPsych Advance, 1-11.
