The current state of behavioral health quality measures: where are the gaps?
Abstract
OBJECTIVE: This review examined the extent to which existing behavioral health quality measures address the priority areas of the National Behavioral Health Quality Framework (NBHQF) as well as the extent to which the measures have received National Quality Forum endorsement and are used in major reporting programs. METHODS: This review identified behavioral health quality measures in widely used measure inventories, including the National Quality Measures Clearinghouse, National Quality Forum, and the Center for Quality Assessment in Mental Health. Additional measures were identified through outreach to federal agencies. Measures were categorized by type, condition, target population, data source, reporting unit, endorsement status, and use in reporting programs. RESULTS: The review identified 510 measures. Nearly one-third of these measures address broad mental health or substance use conditions rather than a specific condition or diagnosis. Seventy-two percent are process measures. The most common data source for measures is administrative claims, and very few measures rely on electronic health records or surveys. Fifty-three (10%) measures have received National Quality Forum (NQF) endorsement, and 28 (5%) unique measures are used in major quality reporting programs. Several subdomains of the NBHQF, such as treatment intensification, financial barriers to care, and continuity of care, lack measures that are NQF endorsed. CONCLUSIONS: Despite the wide array of behavioral health quality measures, relatively few have received endorsement or are used in reporting programs. Future efforts should seek to fill gaps in measurement and to identify the most salient and strongest measures in each priority area.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the US, despite parity laws and more than 500 measures for monitoring mental health care quality, only 5% of these measures are used in major quality reporting programs and only 10% have been endorsed by the National Quality Forum.
“Yet, despite the mental health parity laws passed ten years ago, which stipulate equal coverage for mental health conditions, and the availability of over 500 measures for monitoring quality of mental health care, only 5% of these measures are actually used in the above major quality reporting programs, and only 10% of the measures have been endorsed by the US National Quality Forum 60”
From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [60]
Of the available mental health quality measures, 72% focus on processes quite distal to outcomes rather than on process measures indicating treatment adequacy or intensity.
“Of these available measures, the majority (72%) focus on processes quite distal to outcomes (e.g., screening/assessment) 60 rather than on process measures that indicate treatment adequacy or intensity for mental health care.”
From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [60]
Because many mental health quality measures are not linked to existing data sources, they cannot be automated to generate meaningful data.
“As a result, these measures cannot be automated to generate meaningful data 60 , which in return could support quality measurement and inform routine medical practices and procedures.”
From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [60]
Cites
The Impact of National Health Care Reform on Adults With Severe Mental Disorders
Garfield, R. L., Zuvekas, S. H., Lave, J. R., & Donohue, J. M. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10060792 · Cited by 197 · see citing works
Bao, Y., Casalino, L. P., & Pincus, H. A. (2012) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-012-9306-y · Cited by 113 · see citing works
Challenges and Opportunities in Measuring the Quality of Mental Health Care
Kilbourne, A. M., Keyser, D. J., & Pincus, H. A. (2010) · The Canadian Journal of Psychiatry · doi:10.1177/070674371005500903 · Cited by 110 · see citing works
The Future of Quality Measurement for Improvement and Accountability
Conway, P. H., Mostashari, F., & Clancy, C. M. (2013) · JAMA · doi:10.1001/jama.2013.4929 · Cited by 97 · see citing works
Druss, B. G., & Dimitropoulos, L. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.03.012 · Cited by 32 · see citing works
Developing mental health-care quality indicators: toward a common framework
Fisher, C. E., Spaeth‐Rublee, B., & Pincus, H. A. (2012) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzs074 · Cited by 24 · see citing works
Veterans Health Administration Mental Health Program Evaluation
Watkins, K. E., Pincus, H. A., Smith, B., Paddock, S. M., Mannle, T. E., Woodroffe, A., Solomon, J., Sorbero, M. E. S., Farmer, C. M., Hepner, K. A., et al. (2011) · Cited by 23 · see citing works
Veterans Health Administration Mental Health Program Evaluation Technical Manual
Horvitz-Lennon, M. V., Watkins, K. E., Pincus, H. A., Shugarman, L. R., Smith, B., Mattox, T., & Mannle, T. E. (2009) · PsycEXTRA Dataset · doi:10.1037/e646132010-001 · Cited by 7 · see citing works
Flagged first, then by citations
1 of the 9 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Measuring and improving the quality of mental health care: a global perspective
Kilbourne, A. M., Beck, K., Spaeth‐Rublee, B., Ramanuj, P., O'Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018) · World Psychiatry · doi:10.1002/wps.20482 · Cited by 457 · see citing works
Quality Measures For Mental Health And Substance Use: Gaps, Opportunities, And Challenges
Pincus, H. A., Scholle, S. H., Spaeth-Rublee, B., Hepner, K. A., & Brown, J. (2016) · Health Affairs · doi:10.1377/hlthaff.2016.0027 · Cited by 82 · see citing works
Self-citationEvidence-Based Treatment of Young Adults With Substance Use Disorders
Hadland, S. E., Yule, A. M., Levy, S., Hallett, E., Silverstein, M., & Bagley, S. M. (2021) · PEDIATRICS · doi:10.1542/peds.2020-023523d · Cited by 69 · see citing works
Measurement-based management of mental health quality and access in VHA: SAIL mental health domain.
Lemke, S., Boden, M. T., Kearney, L. K., Krahn, D. D., Neuman, M. J., Schmidt, E. M., & Trafton, J. A. (2017) · Psychological Services · doi:10.1037/ser0000097 · Cited by 44 · see citing works
Dudley, L., Mamdoo, P., Naidoo, S., & Muzigaba, M. (2022) · BMJ Health & Care Informatics · doi:10.1136/bmjhci-2021-100469 · Cited by 29 · see citing works
Quality indicators for care of depression in primary care settings: a systematic review
Petrosyan, Y., Sahakyan, Y., Barnsley, J. M., Kuluski, K., Liu, B., & Wodchis, W. P. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0530-7 · Cited by 27 · see citing works
Association between process measures and mortality in individuals with opioid use disorders
Watkins, K. E., Paddock, S. M., Hudson, T. J., Ounpraseuth, S., Schrader, A. M., Hepner, K. A., & Stein, B. D. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2017.03.033 · Cited by 23 · see citing works
Petrosyan, Y., Sahakyan, Y., Barnsley, J. M., Kuluski, K., Liu, B., & Wodchis, W. P. (2017) · Family Practice · doi:10.1093/fampra/cmx090 · Cited by 22 · see citing works
Luther, L., Fukui, S., Garabrant, J. M., Rollins, A. L., Morse, G. A., Henry, N. H., Shimp, D., Gearhart, T., & Salyers, M. P. (2018) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-018-9601-3 · Cited by 22 · see citing works
The Adult ADHD Quality Measures Initiative
Faraone, S. V., Silverstein, M. J., Antshel, K. M., Biederman, J., Goodman, D. W., Mason, O., Nierenberg, A. A., Rostain, A. L., Stein, M. A., & Adler, L. A. (2018) · Journal of Attention Disorders · doi:10.1177/1087054718804354 · Cited by 21 · see citing works
Quality Measures at the Interface of Behavioral Health and Primary Care
Goldman, M. L., Spaeth‐Rublee, B., Nowels, A. D., Ramanuj, P., & Pincus, H. A. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0671-8 · Cited by 20 · see citing works
Gallo, J. J., Hwang, S., Truong, C., Reynolds, C. F., & Spira, A. P. (2020) · SLEEP · doi:10.1093/sleep/zsaa063 · Cited by 18 · see citing works
Performance Measurement in Mental Health and Addictions Systems: A Scoping Review
Urbanoski, K. A., & Inglis, D. (2019) · Journal of Studies on Alcohol and Drugs Supplement · doi:10.15288/jsads.2019.s18.114 · Cited by 17 · see citing works
Marti, F., Pourat, N., Lee, C. W., & Zima, B. T. (2021) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-021-01157-z · Cited by 16 · see citing works
A Quality Measurement Framework for Emergency Department Care of Psychiatric Emergencies
Im, D. D., Scott, K. W., Venkatesh, A. K., Lobon, L. F., Kroll, D. S., Samuels, E. A., Wilson, M. P., Zeller, S. L., Zun, L. S., Clifford, K. C., et al. (2022) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2022.09.007 · Cited by 12 · see citing works
Callen, E. F., Clay, T. L., Alai, J., Goodman, D. W., Adler, L. A., Shields, J. B., & Faraone, S. V. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231155875 · Cited by 11 · see citing works
Zima, B. T., Marti, F., Lee, C. E., & Pourat, N. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201800424 · Cited by 10 · see citing works
Performance Metrics of Substance Use Disorder Care Among Medicaid Enrollees in New York, New York
Alegria, M. M., Falgas‐Bagué, I., Fukuda, M., Zhen‐Duan, J., Weaver, C., O’Malley, I. S., Layton, T., Wallace, J., Zhang, L., Markle, S. L., et al. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.1771 · Cited by 9 · see citing works
Improving the Quality of Care for Serious Mental Illness
Young, A. S., Cohen, A. N., & Miotto, K. A. (2016) · Springer eBooks · doi:10.1007/978-3-319-26209-3_18 · Cited by 9 · see citing works
Hepner, K. A., Paddock, S. M., Watkins, K. E., Ounpraseuth, S., Schrader, A. M., & Hudson, T. J. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201600484 · Cited by 8 · see citing works
Driving Access and Quality: A Shift to Value-Based Behavioral Health Care
Knutson, K. H., Wennberg, D. E., & Rajkumar, R. (2021) · Psychiatric Services · doi:10.1176/appi.ps.202000386 · Cited by 7 · see citing works
Surveying the Landscape of Quality-of-Care Measures for Mental and Substance Use Disorders
Schmidt, E. M., Liu, P., Combs, A., Trafton, J. A., Asch, S. M., & Harris, A. H. S. (2022) · Psychiatric Services · doi:10.1176/appi.ps.202000913 · Cited by 5 · see citing works
From Alienism to ACOs: Integrating Psychiatry, Again
Sisti, D. A., & Ramamurthy, C. (2015) · Psychiatric Services · doi:10.1176/appi.ps.201500400 · Cited by 5 · see citing works
Qi, A. C., Maddox, K. E. J., Bierut, L. J., & Johnston, K. J. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.0212 · Cited by 5 · see citing works
Advancing the Measurement of Care Coordination in Pediatric Behavioral Health
Jorina, M., Cammaerts, A., Singer, J., Ozonoff, A., Chan, E., Antonelli, R. C., Gurvitz, M. Z., & Jenkins, K. J. (2016) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000000350 · Cited by 4 · see citing works
Hepner, K. A., Roth, C. P., O’Hanlon, C. E., & Marsolais, E. (2023) · RAND Corporation eBooks · doi:10.7249/rra2522-1 · Cited by 3 · see citing works
Menear, M., Gagnon-Harvey, A.-A., Rivet, S., & Gabet, M. (2023) · Santé mentale au Québec · doi:10.7202/1109833ar · Cited by 3 · see citing works
Williams, N. J., Beauchemin, J. D., Giuntini, G., Griffis, J., & Mo, Y. (2021) · Journal of Emotional and Behavioral Disorders · doi:10.1177/10634266211028204 · Cited by 3 · see citing works
Value-based care for behavioral health: A more measured approach to achieve true value
Connors, E. H., & Mayes, L. C. (2026) · npj Mental Health Research · doi:10.1038/s44184-026-00198-2 · Cited by 2 · see citing works
Riblet, N. B. V., Gottlieb, D. J., Shiner, B. R., Zubkoff, L., Rice, K., & Rusch, B. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209514 · Cited by 2 · see citing works
Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia
Fochtmann, L. J., Medicus, J., & Hong, S.-H. (2020) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20200034 · Cited by 2 · see citing works
A Value Framework for Transforming Behavioral Health
Knutson, K. H. (2021) · NEJM Catalyst · doi:10.1056/cat.21.0037 · Cited by 2 · see citing works
Koscelny, S. N., Zeinali, F., Gripko, M., Neyens, D. M., Taaffe, K., & Joseph, A. (2026) · Health Systems · doi:10.1080/20476965.2026.2715989 · Cited by 1 · see citing works
Utilizing a Dashboard to Promote System-Wide Value in Behavioral Health
Runnels, P. S., Coran, J. J., Goldman, M. L., & Pronovost, P. J. (2020) · Population Health Management · doi:10.1089/pop.2020.0233 · Cited by 1 · see citing works
Nowlin, R. B., Brown, S. K., Ingram, J. R., & Smith, J. R. (2021) · Journal for Healthcare Quality · doi:10.1097/jhq.0000000000000319 · Cited by 1 · see citing works
Elevating Patient Voices to Improve Opioid Use Disorder Quality Measurement: A Survey Protocol
Barnes, A. J., Hale, C., D’Angelo, Z., Kennedy, S., Reidt, J. T., Mcclure, C. L., Marks, S. J., Harris, T. T., Reine, L., Gualchi, L., et al. (2026) · Substance Use & Addiction Journal · doi:10.1177/29767342261463426 · Cited by 1 · see citing works
(2016) · Psychiatric Services · doi:10.1176/appi.ps.674correction
(2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9780890424865.eatingdisorder07
Implementation Science in Healthcare
Hamilton, A. B., & Brown, A. F. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197660690.003.0021
Chapter 19. Quality, Measurement-Based Care, and Outcomes
(2022) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379729.lg19
Young, A. S., Cai, L., JACKSON, N. J., Leung, L. B., & Thames, A. D. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-105270
- Authors
- Patel, M. M., Brown, J. D., Croake, S., Lewis, R., Liu, J., Patton, L., Potter, D. E. B., & Scholle, S. H.
- Affiliations
- United States Department of Health and Human Services (US)
- Venue
- Psychiatric Services
- Published
- 2015-08-01
- Volume
- 66
- Issue
- 8
- Pages
- 865-871
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W1943590152
- Cited by
- 41
- References
- 9
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 5 · 2016: 5 · 2015: 1
- FWCI
- 8.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Mathematica Policy Research Reports (submittedVersion)
- Funders
- U.S. Public Health Service (HHSP23320100019WI, HHSP23337001T)
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- mental health, substance use disorders, process indicators, data sources, financial barriers to care, continuity of care, treatment intensification, measurement gaps
- MeSH terms
- Humans, Mental Health Services, Quality Indicators, Health Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
