Working with clinical complexity and challenges in engagement

Engagement is fundamental to successfully treating early psychosis. If a young person is well engaged with their treatment, they are more likely to attend services, participate meaningfully in therapy and adhere to medication, all of which increase their chances of recovery. Unfortunately, engagement is not always straightforward, and up to a third of young people may disengage from early psychosis services in the long term.

The reasons for this are numerous, complex, and – although there may be themes in common – unique to each young person’s circumstances. Although it is easy to blame disengagement on simple factors such as the young person’s attitude or symptoms, viewing engagement in such simplistic terms represents a lost opportunity to intervene and enhance engagement. Rather, clinicians and services need to consider the challenges and complexities of poor engagement and find ways to address them.

This clinical practice point is designed to help clinicians who work with young people with early psychosis to understand:

  • The complexity of the factors that influence a young person’s engagement with services

  • How to promote engagement

  • The importance of working with the young person’s system, including their family and other services

  • What to do when young people continually won’t engage.


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