CAHPS Mental Health Surveys

Many organizations are interested in assessing and improving patient experience with behavioral health, mental health, and/or substance use disorder services. Three CAHPS products are available to address this need:

• New in 2024: CAHPS Outpatient Mental Health Survey.
• Supplemental items on access to mental health care services for the CAHPS Clinician & Group Survey and the CAHPS Health Plan Survey. 
• CAHPS Experience of Care and Health Outcomes (ECHO) Survey.

CAHPS Outpatient Mental Health Survey

The CAHPS Outpatient Mental Health Survey asks adult patients about experiences with mental health and substance use disorder services received in any outpatient setting. The CAHPS research team developed this instrument in response to changes in the ways these services are provided and as a replacement for the CAHPS ECHO Survey (described below). 

The questions in the Outpatient Mental Health Survey focus on experiences with treatment and counseling services, including getting help between appointments and potential barriers to care. The survey results can be used to assess patient experience and identify strengths as well as areas in need of improvement. Potential users of this survey include mental health providers, medical groups, hospitals, health systems, health plans, healthcare monitoring organizations, and State agencies. Learn about the development of the Outpatient Mental Health Survey.

Get the CAHPS Outpatient Mental Health Survey

The Outpatient Mental Health Survey is a standardized instrument for adults who received mental health or substance use disorder services in the previous 6 months.

• Review the Outpatient Mental Health Survey—English (PDF, 208 KB)
• Guidelines for Using the CAHPS Outpatient Mental Health Survey (PDF, 340 KB)  

Download the Outpatient Mental Health Survey (ZIP, 692 KB)

The ZIP file includes the instrument in English and Spanish, and guidance on how to use the survey.

Users of this survey can consult the following guidance on using CAHPS surveys:

• CAHPS survey design and administration.
• Translating surveys and other materials.
• Analyzing CAHPS survey data.

Webcast on the Outpatient Mental Health Survey 

Introducing the CAHPS Outpatient Mental Health Survey (Webcast) (October 17, 2024)  

Introducing the CAHPS Outpatient Mental Health Survey (Webcast) (1:02:15)

Review questions asked during this webcast.

Quality Measures from the CAHPS Outpatient Mental Health Survey

The CAHPS Outpatient Mental Health Survey produces the following measures of patient experience:

• Getting Appointments for Prescription Medicines (Q3).
• Getting Mental Health Counseling (Q10, Q12).
• Communication with Mental Health Counselor (Q13, Q14).
• Goal Setting (Q16).
• Getting Help Between Appointments (Q21).
• Rating of Mental Health Counselor (Q22).
• Unmet Need for Mental Health Services (Q23).
• Financial Barriers to Mental Health Services (Q25).

Review measures from the CAHPS Outpatient Mental Health Survey

Supplemental Items: Access to Mental Health Care

Users of the CAHPS Health Plan Survey or CAHPS Clinician & Group Survey can add a short set of six questions to ask respondents about their experiences with access to mental health services. These items were released in 2021.

• Review supplemental mental health care items for the Health Plan Survey.
• Review supplemental mental health care items for the Clinician & Group Survey.

Learn more: 

• Measuring Access to Mental Health Services Among Primary Care Patients. Hargraves, J. Lee PhD, MA; Cosenza, Carol MSW; Cleary, Paul D. PhD. Medical Care 62(8):p 559-566, August 2024. | DOI: 10.1097/MLR.0000000000002029

Experience of Care & Health Outcomes (ECHO) Survey

The CAHPS Experience of Care and Health Outcomes (ECHO) Survey asks health plan enrollees about their experiences with behavioral healthcare and services. Released in 2003, the ECHO Survey was the result of a collaborative effort to evaluate and merge the original Consumer Assessment of Behavioral Health Survey (CAHBS) and the Mental Health Statistics Improvement Program (MHSIP) survey. Learn about the development of the ECHO Survey.

The ECHO Survey has separate versions for Managed Care Organizations (MCOs) and Managed Behavioral Health Organizations (MBHOs).  This survey is appropriate for patients with a range of service needs, including those with severe mental illness, but does not include questions about inpatient stays or self-help groups.

The ECHO Survey is used for multiple purposes:

• To improve the quality of mental health and substance use disorder services.
• To evaluate and monitor the quality of behavioral healthcare organizations.
• To hold providers accountable through public reporting.

Users of the ECHO Survey have included State Medicaid agencies, State mental health agencies, managed behavioral health organizations (MBHOs), and managed care organizations (MCOs).

Get the ECHO Survey

The ECHO Survey 3.0 includes standardized instruments and optional supplemental items for adults and children who received mental health or substance use disorder services in the previous 12 months through a managed care organization or managed behavioral healthcare organization. Supplemental items are available for adults only.

Download the Managed Care Organization (MCO) Survey and Instructions (ZIP, 4 MB)

The MCO Survey asks enrollees about treatment, counseling, and administrative services, such as experiences filling out paperwork or finding information in written materials. The Adult version is available in English and Spanish; the Child version is available in English only.

Download the Managed Behavioral Health Care Organization (MBHO)  Survey and Instructions (ZIP, 4 MB)

The MBHO Survey asks enrollees primarily about treatment and services; only a few questions focus on administrative services. The Adult version is available in English and Spanish; the Child version is available in English only.

Note: Information in the guidance documents is based on the survey developers' extensive research into best practices in survey design and administration as well as analyses of data collected during the field testing of each instrument. AHRQ does not require the use of a specific methodology for sampling or survey administration.

Also, the documentation available for the ECHO Survey does not reflect recent changes (e.g., changes in administrative codes) or refinements in the sampling guidance provided for newer CAHPS surveys. 

Users of this survey can consult the following guidance on using CAHPS surveys:

• CAHPS survey design and administration.
• Translating surveys and other materials.
• Analyzing CAHPS survey data.

If you have questions about the ECHO Survey, please contact the CAHPS Help Line at CAHPS1@westat.com.

Quality Measures From the ECHO Survey

Measures for adults: The ECHO Survey for adults produces the following measures of patient experience:

• Getting treatment quickly.
• How well clinicians communicate.
• Getting treatment and information from the plan (or MBHO).
• Perceived improvement.
• Information about treatment options.
• Overall rating of counseling and treatment (MCO and MBHO).
• Overall rating of the health plan (MCO only).

Ten questions can be reported as single-item measures:

• Having to wait in the office.
• Being told about medication side effects.
• Including family and friends in treatment.
• Getting enough information to manage the condition.
• Getting information about patient rights.
• Whether the patient feels that he or she can refuse treatment.
• Privacy of information.
• Cultural competency.
• Helpfulness of counseling or treatment.
• Getting treatment after benefits are used up.

Review measures from the CAHPS ECHO Survey 3.0.

Measures for children. The CAHPS team did not develop and test a set of measures from the child version of the surveys.