Articles
August 3, 2021

5 Tips on How to Reduce No-Shows

While no-shows are fairly common in mental healthcare, they can also be problematic. The good news is, there are things you can do to minimize them.

Kate Dubé

Kate Dubé

Kate Dubé is a Licensed Clinical Social Worker (LCSW) and mental health writer trained at UC Berkeley and UCSF. She incorporates her research and clinical expertise to create well-researched, accessible content on topics ranging from the individual to the systemic. When you—or a loved one—is struggling with a mental health issue, you can rely on her for evidence-based, empathetic, and useful information. Find Kate at: linkedin.com/in/kate-dube

There are many reasons why a client won’t show up for an appointment – they’re sick, overwhelmed with other tasks, they double-booked, forgot, no longer want to attend therapy but weren’t sure how to tell you, or are expressing a symptom of their presenting issue.

While no-shows are fairly common in mental healthcare, they can also be problematic for providers. They have the potential to impact your bottom line, leave you with an opening that you can no longer fill, and negatively impact treatment.    

The good news is, there are things that you can do to minimize no-shows and late cancellations. Below are 5 tips that you can implement today.

1. Send Appointment Reminders

One way to improve appointment attendance is to send reminder texts and emails or make reminder calls. These reminders usually go out a few times within the week before the appointment and work by jogging the client’s memory and offering them the opportunity to cancel within your accepted no-fee cancellation limits.  

If you have a front office staff, they can call or text clients to confirm each appointment, or even easier, you can set up automated reminders to go out through your HIPAA secure platform. Be sure to include the date and time of the appointment and leave out any personal or sensitive information as you don’t know who else might see the text.

2. Reduce the Appointment Wait Time

No-show rates are known to be proportional to the number of days between the date that an appointment is booked and the actual appointment. For example, an appointment scheduled 5 days in advance typically has half the no-show rate compared to an appointment scheduled 2 weeks out. It makes sense–people forget, plans change, life happens.

To reduce no-shows, try to limit scheduling appointments to no more than 2 or 3 weeks in advance, rather than booking them a month or more out. If your schedule is full for the next 2 or 3 weeks, consider putting a temporary pause on accepting new clients to prevent a spike in your no-show rate.

3. Practice Measurement-Based Care

Measurement-based care has been shown to help clients feel more involved and become active participants in their own mental health treatment. Offering outcome measures not only encourages self-reflection between sessions but also sparks essential conversations during sessions.

No longer stifled by the fear or apprehension that comes with not knowing what to talk about, measurement-based care gives clients a basis to discuss their treatment goals, progress, barriers, and any adjustments that may need to happen. This improves the therapeutic alliance, keeps clients engaged, and encourages them to show up to their visits.

For example, Move Forward Counseling, a behavioral health practice in Lancaster, Pennsylvania, started practicing measurement-based care using Blueprint and reduced their cancelled appointments by 25 percent.

Download the Move Forward Case Study

4. Create a Cancellation Policy

Whether you’re in private practice or with an agency, a cancellation policy allows you, as the mental health provider, to set clear expectations with your clients around late cancellations and no-shows.

Be upfront about your cancellation policy and put it in writing as part of your informed consent process. A good cancellation policy should include

  • The amount of time before a scheduled appointment that it’s acceptable to cancel
  • What will happen if a client cancels beyond that allotted time or doesn’t show
  • The fee charged for a late cancellation or no-show
  • Any exceptions you choose to make–including one freebie or urgent medical issues

If a client misses multiple appointments or no-shows become a pattern, it’s essential that you take the time to explore what’s going on and use it as a therapeutic intervention. Simply collecting no-show fees and leaving it up to the client to deal with the consequences is unethical and is missing a great opportunity in therapy.

5. Understand Why

For one-off cancellations or no-shows due to unexpected issues, there’s not much you can do to prevent them. But if you’re noticing a pattern, look a little bit deeper to see if you can identify any core issues.

Be open-minded and curious as you try to understand. When you have accurate information, you’ll be able to find which levers to pull to make the biggest impact. It might be that you need to explore readiness in your intake process, demystify the therapy experience for new clients, make an agreement to have a closing session if a client chooses to terminate, or review your cancellation policy verbally.  

You Can Make Minor Tweaks to Minimize No-Shows

No-shows are inevitable and they’re bound to happen to every mental health provider from time to time. We recommend factoring in a 10-20% cancellation and no-show rate when planning your schedule. So if you want to see 20 people each week, schedule 22-24 clients assuming a couple may cancel and another one or two may not show. Implement these five tips to get yourself closer to the 10% range while keeping your clients engaged and your practice healthy and thriving.