A New CAHPS Measure of Patient Experiences With Mental Health and Substance Use Care

To examine the psychometric characteristics of a survey about the experiences of people seeking mental health care and substance use services, the CAHPS Outpatient Mental Health (MH) survey.

Field tests were conducted in two Northeastern states-one among a state's Medicaid enrollees and the other in family medicine practices where psychologists and social workers were collocated with primary care providers. The survey asked about psychiatric medicines and counseling services received in the last 6 months.

In each study, questionnaires were mailed to sampled patients with an option to complete a web survey. Study 1 included 5508 Medicaid enrollees 21 years and older from four health plans. Study 2 included 3328 patients 18 years and older who visited one of four family medicine practices. Samples included patients with mental health or substance use disorders or both.

Response rates were 9.98% (n = 470) and 13.00% (n = 416) for the Medicaid and family medicine surveys, respectively. About 20% of respondents reported difficulty getting appointments with mental health medicine prescribers. From 10% to 30% of respondents had difficulties finding a counselor, and 15% reported problems making appointments with counselors. Many respondents reported no mental health care in the last 6 months. Composite measures for communication with counselors had excellent internal consistency, but the measure for access to counseling services was modest (0.68 and 0.52 for the two studies). Inter-unit reliability (IUR) was modest for the survey (IUR for all measures was lower than 0.60; highest for rating of counselors).

Both studies had uniformly good distributions of responses to specific questions, although communication and respect questions about counselors were positively skewed. The survey performs better for respondents with any mental health condition and less well for those with only substance use disorders.