An investigation of failures to keep appointments and reluctance to refer individuals in obvious need of psychiatric assistance was conducted in an Army division psychiatric section. Making use of formal and informal channels of communication within the military community, the investigators were able to explore the basic question of failure to take advantage of the mental health facility.The study indicated that several interrelated factors appeared to be associated with the problem: 1. The attitude of the individual patient; 2. The attitude of the group within which the individual lived and worked; and 3. The attitude of the origin of the referral. These three sources contained a variety of fears, unrealistic expectations, and misconceptions about the psychiatric service. Where conflicts arose as a result of these misunderstandings, the end product was the failure to utilize the mental health facility.Because of these discoveries, a more intensive educational program and an increase of primary contacts with sources of referrals and units within the division were made. These efforts have resulted in a dramatic decrease in the number of appointment failures and an increase in new referrals.Even though this study was conducted in a military rather than a civilian setting, it appears the knowledge gained has applicability to both. It seems evident that consideration must be given to those forces outside the psychotherapeutic process which impede the use of available psychiatric assistance. Of equal importance is the necesity for the psychiatrist to be aware of the basic problem of failure to keep appointments in his own community and to ascertain what courses of action he might take to reduce these conflicting attitudes.Abstract Teaser