Study: INTERFACE helps to overcome barriers to engagement in mental health care

In April 2017, a research study was conducted on the INTERFACE Referral Service to assess factors associated with disengagement in Mental Health Care. This study evaluated how INTERFACE fared in comparison to national data related to resource and referral.   This is a critical area to examine, as initial appointment non-attendance occurs twice as often in mental health care settings as compared to any other specialty care setting. The study looked at intake records of 467 individuals with 67.2% of the individuals under the age of 25 and 32.5% of the individuals age 25 and older. Highlights from this study are listed below:

People contact the William James INTERFACE Referral Helpline to address a variety of mental health needs. 

  • Intake case records indicated that callers were looking for help with stress or anxiety, depression, family crisis, and trauma, yet there were a broad range of issues and concerns cited in the intake for which callers were seeking specialized care.
  • In most cases, people were seeking individual therapy and associated psychiatric medical treatment.
  • Most people were interested in appointments after school hours or in the evening.

This study looked at the barriers to accessing treatment including insurance, provider availability, geographic location of help seeker and provider, transportation, and mental health literacy. The INTERFACE Referral Service offers assistance with the process of finding a therapeutic match by utilizing a gatekeeper model of mental health care assistance long studied in the literature (Stiffman, Prescosolido, and Cabassa, 2004 as cited in Brevik, 2017) which helped to mitigate barriers to treatment. The service model includes matched referrals at a rate of 100% to reported insurance, provider availability, geographic location, transportation needs. The referrals were provided by staff trained and skilled in mental health literacy. The William James INTERFACE Referral Helpline was cited as an important resource for locating a mental health provider.

This study aimed to look at disengagement factors in mental health treatment after a referral to services from a resource and referral program. While no current literature exists to establish a baseline for rate of disengagement in services after referral through a mental health referral helpline, literature does exist on disengagement from mental health programs. This literature reports that individuals disengage from services after any kind of referral at an average rate of 30%. This study found individuals who used the INTERFACE comprehensive referral service to disengage at a much lower rate of 1.3% during the initial phase of the referral process and 7.5% in the second phase of the process. On average, participants received a referral to services within 2.9 days. Many studies measure referrals in weeks or months not days, and therefore the low disengagement rates reported in this study can be attributed to the rapid turnaround by the INTERFACE Referral Service. 

  • INTERFACE has a robust database with 7,281 providers. This database is constantly vetted and updated which likely contributes to the swift turnaround in matching help seekers to services
  • National data indicate initial appointment non-attendance occurs at a rate of 20% to 57% within the mental health care field and disengagement rates are estimated at approximately 30% across populations.  Current evaluation results indicated that participants disengaged from the Interface program at a lower rate than those documented in the literature (27.6%).  These results demonstrate that INTERFACE is successful not only in helping people access services, but in supporting them through the process of finding the right match and establishing sustained care.
  • Particularly vulnerable for not making initial appointments are people who experience a long delay between initial point of contact and scheduled appointment.  The average time between initial contact and scheduled appointment for those who used INTERFACE Referral Service, is 14 days.


The study found that disengagement rates through the INTERFACE Referral Service, a comprehensive mental health referral program that utilizes a gatekeeper model of service, were lower than average disengagement rates in the literature (O’Brien, Fahmy & Singh, 2009, as cited in Brevik, 2017). Further, the study found that, disengagement rates were not associated with demographic characteristics of participants (age, race, ethnicity, employment, or annual household income) nor were they associated with the nature of the presenting concern of the participant, or the amount of time that it took to receive a referral for mental health care. Results from this study have limitations with regard to the interpretation of the data as the participant sample was self-selected and largely homogeneous. Despite this, the results suggest that comprehensive referral programs may assist individuals in navigating the many complexities of the mental health care system, thus decreasing disengagement rates. Further, the data suggest that comprehensive referral programs may assist populations who are most vulnerable to disengagement by mitigating disruptions in the help-seeking process (Brevik, 2017).


Brevik, S. (2017). Factors Affecting Mental Health Care Disengagement through the Utilization of a Comprehensive Referral Program. (Unpublished doctoral dissertation). William James College, Newton, MA.