Up to a third of clients referred to National Health Service (NHS) mental health services will miss their first appointment. Opt-in systems are widely used to reduce non-attendance but there has been little published research examining the effects of such methods on clients. A cohort study with non-randomised historical controls was used to examine the introduction of an opt-in letter as the route to a first appointment in an NHS psychotherapy service.
The introduction of the opt-in letter slightly reduced non-attendance rates for first appointments, but this was at the expense of overall access to the service for the highest prevalence disorders.
It appears that although an opt-in system can reduce non-attendance at first appointments, it may have an unintended consequence of denying access to clients with the most common mental health problems such as anxiety disorders and depression.
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