Mental Health Service Engagement Among Young Adults with Mental Health Challenges

Purpose:Lack of engagement in mental health services continues to be a troubling problem, particularly among youth and young adults. Recent studies suggest 40% to 60% of adolescents terminate treatment early. To date, most studies have investigated engagement utilizing a dichotomous measure of attendance. More recent frameworks are calling for increased attention to the varying layers of the eco-system related to engagement and to measurement that moves us beyond examining engagement dichotomously. The purpose of this study was to explore engagement with outpatient services at a mental health clinic and medication services utilizing an innovative continuous measure adapted from the child welfare literature (Yatchmenoff, 2005). The measure captures variation in dimensions of engagement, such as level of investment and the therapeutic relationship. This study examines the internal consistency/reliability of the measure. The study also examines variation in engagement by demographic, clinical, and cognitive factors.

Method: Sixty young adults from one Midwestern State were interviewed face-to-face on their mental health service use and engagement experiences. All participants share three childhood experiences: (1) diagnoses of a mood disorder, (2) use of Medicaid-funded mental health services, and (3) use of at least one additional public system of care. All participants who had used a community mental health clinic (N=58) and psychotropic medication (N=52) were asked their level of agreement on a five point scale with a series of seven statements regarding engagement in that service (e.g., I’m really involved in working with the community mental health clinic). Univariate statistics were examined on the engagement measure. Then, bivariate statistics were examined for correlations significant at the p<.05 level. Ordinary least squares regression models were constructed, including predictors significant at the bivariate level. Then, backwards elimination was utilized due to the small sample size.

Findings: Results revealed a high level of internal consistency among the Client Engagement items utilized to measure engagement in outpatient mental health services (α=0.91) and psychotropic medication (α=0.87). On the bivariate level, ethnicity, current depression, attending school, attitudes towards services, perceptions of mental health challenges, willingness to seek services and mistrust of health care were associated with the level of engagement in outpatient and/or medication services. When examining the multivariate model of engagement in outpatient mental health services, depression B=-0.13, t(56)=-2.04, p<.05, attitudes B=0.19, t(56)=3.28, p<0.01, and willingness to seek counseling B=0.26, t(56)=2.09, p<.05 remained significant and explained 48% of the variance in engagement F(56)=14.20, p<.0001. The multivariate model for engagement with medication was significant F(58)=4.73, p<.05, however, predictors were only marginally significant.  

Implications: The present study documents the innovative adaptation of Yatchmanoff’s measure of engagement from child welfare services to mental health services.  The multi-dimensional, continuous measure is reliable among young adults with mental health challenges.  The development of a valid and reliable measure of mental health services engagement for youth and young adults builds on the existing literature, and extends the focus to dimensions of engagement, such as investment and therapeutic alliance.