ORIGINAL PAPER

Predictors of Consumer Satisfaction in Community Mental HealthCenter Services

Minji Sohn • Hope Barrett • Jeffery Talbert

Received: 12 September 2012 / Accepted: 20 January 2014

� Springer Science+Business Media New York 2014

Abstract Kentucky Department for Behavioral Health

Developmental and Intellectual Disabilities conducted a

survey to evaluate consumers’ satisfaction with services

delivered at the Community Mental Health Centers

(CMHCs) in Kentucky. The survey was administered at

outpatient clinics operated by fourteen CMHCs in 2010.

The purpose of this study was to identify factors that pre-

dict whether clients will respond that they were ‘‘generally

satisfied’’ with services received from CMHCs. A logistic

regression model was developed using respondents’ char-

acteristics and their responses to survey questions. Survey

questions were grouped into seven core domains: general

satisfaction, access, quality, participation in treatment

planning, outcomes, functioning, and social connectedness.

In result, responses to domains of access, quality and

participation in treatment planning significantly affected

clients’ perception of general satisfaction. Respondents

who positively assessed those domains of services were

more likely to answer that they were generally satisfied

with services. Based on the analysis in this report,

improvement in certain domains of services, especially

access, quality and participation in treatment planning

could increase the level of positive responses in general

satisfaction.

Keywords Community Mental Health Centers

(CMHCs) � Satisfaction � Access � Quality � Participation in

treatment planning

Introduction

In 2010, the Kentucky Cabinet for Health and Family

Services, Department for Behavioral Health Developmen-

tal and Intellectual Disabilities (BHDID) conducted a sur-

vey to evaluate consumers’ satisfaction with services

delivered at the Community Mental Health Centers

(CMHCs) in Kentucky. The survey was developed by the

Mental Health Statistics Improvement Program (MHSIP)

Advisory Committee of the Center for Mental Health

Services (CMHS) and was designed to assess the clients’

perspectives on public mental health services they have

received (Leginski et al. 1989; Carlson et al. 2010; Minsky

and Lloyd 1996; Jerrell 2006; Ganju 1999; Ganju et al.

1996).

The purpose of this study was to scrutinize factors that

affect clients’ perception of ‘‘general satisfaction’’. Do

people positively respond as ‘‘generally satisfied’’ when the

treatment outcomes are improved, or when they meet

doctors quickly and conveniently without waiting in a long

line? This study attempts to answer the question by ana-

lyzing the relative association of general satisfaction with

responses to other survey questions. More specifically, the

survey asked about several aspects of services received,

such as general satisfaction, access, quality, participation in

treatment planning, outcomes, functioning and social con-

nectedness. Also, patients’ characteristics such as gender,

race and birth date were obtained in the survey. Because

the analysis was performed only using survey responses,

findings in this report may not reflect all of the factors

M. Sohn (&) � J. Talbert

College of Pharmacy, University of Kentucky, 789 South

Limestone Street, Lexington, KY 40536-0596, USA

e-mail: minjisohn@uky.edu

H. Barrett

Kentucky Department for Behavioral Health Developmental

Intellectual Disabilities, Kentucky Cabinet for Health and

Family Services, 100 Fair Oaks Lane 4E-A, Frankfort,

KY 40601, USA

123

Community Ment Health J

DOI 10.1007/s10597-014-9702-2

influencing general satisfaction. Also, the survey was

administered only to participants visiting a CMHC.

Therefore, clients who are no longer receiving services are

not included in the report, implying that the analysis might

draw different conclusion otherwise.

Methods

The survey was administered at outpatient clinics operated

by fourteen CMHCs in Kentucky. During a 2 weeks period

each spring, the CMHC staff made the survey available to

clients who arrived for outpatient appointments. Complet-

ing the survey was voluntary and had no implications for

appointments or services provided.

The surveys had seven core domains and each set of

related questions asked about a specific aspect of services

provided. (Table 1) For each question, possible responses

were arrayed on a five point scale that ranges from

‘‘strongly agree’’ to ‘‘strongly disagree’’. For example, for a

question, ‘‘I felt free to complain’’, respondents were able

to choose one answer out of six choices: strongly agree,

agree, neutral, disagree, strongly disagree and don’t know/

not applicable. The responses of ‘‘agree’’ and ‘‘strongly

agree’’ were considered as positive responses. In the ana-

lysis, responses of ‘‘don’t know/not applicable’’ were

treated as missing values and not included in calculating

percent responses of each question. Also, surveys with

more than 1/3 of the items in the scale missing were

excluded from the result of that scale.

A logistic regression model was developed to predict

general satisfaction. Patient demographics (age, sex, race)

and region of residence (urban, rural), and the responses to

other domains of the survey were included as explanatory

variables.

Results

During the fiscal year 2010 (July 1, 2009–June 30, 2010),

117,526 adult patients visited Kentucky CMHCs and 7,029

of them participated in the survey, resulting in a 5.98 %

penetration rate. Table 2 shows the demographic charac-

teristics of survey respondents. Approximately 74 % of

respondents were age 18–50, with the mean of 41.2. For

race, a high proportion of respondents were white (90 %).

This could be explained by a high rate of white residents in

Kentucky. In fact, this observation is consistent with the

2010 US Census Bureau data showing that Kentucky

consists of over 87 % of white residents (US Census

Bureau 2010).

Approximately 92 % of participants responded posi-

tively on the domain of general satisfaction. (Figure 1) It

was the second highest following to the domain of quality

where 94 % responded positively. The domains of access,

Table 1 Primary concerns related to domain

Domain Primary concerns related to domain

General satisfaction Services were, overall, satisfactory and

preferable to other choices (e.g., I like the

services that I receive here. I would

recommend this agency to a friend or

family member)

Access Staff availability, the range of service

options and how quickly and conveniently

services were received (e.g., Staff returned

my call in 24 h. Services were available at

times that were good for me)

Quality/

appropriateness

Cultural and linguistic access and whether

services promoted recovery and continuity

of care (e.g., Staff was sensitive to my

cultural background. I was given

information about my rights. Staff told me

what side effects to what out for)

Participation in

treatment Planning

Clients’ participation in planning services

(e.g., I, not staff, decided treatment goals)

Outcomes Services provided patients with positive

changes in areas for which treatment was

sought and minimal negative outcomes

(e.g., I deal more effectively with daily

problems. I am better able to control my

life)

Social connectedness Services contributed to improving natural

supports, which come from family or

friends (e.g., I have people with whom I

can do enjoyable things. I am happy with

the friendships I have.)

Functioning There was a positive effect on independent

community living and decreasing distress

caused by symptoms (e.g., I am better able

to do things that I want to do. I am better

able to handle things when they go wrong)

Table 2 Adult survey respondents’ characteristics

Age of adult

respondents

Gender of

adult

respondents

Race of adult respondents

18–30 24 % Male 40 % American Indian/Alaska

Native

2 %

31–40 25 % Female 60 % Native Hawaiian 0.1 %

41–50 25 % Total 6,346 Asian 0.3 %

51–60 19 % White (Caucasian) 90 %

61–70 6 % Black (African–

American)

7 %

71–80 1 % Other 1 %

C81 0.2 % Total 6,222

Total 5,251

Community Ment Health J

123

participation in treatment planning, outcomes, social con-

nectedness, and functioning showed the relatively lower

level of positively response compared to general satisfac-

tion. Especially, outcomes and functioning were the lowest

(73 %).

Next, we used a multivariable logistic regression to

predict general satisfaction using respondents’ character-

istics and survey responses to other domains.(Table 3) In

result, females were more likely to respond positively on

general satisfaction (odds ratio: 1.55). Compared to white,

American Indian were less likely to answer positively on

general satisfaction (odds ratio: 0.2). Age and regional

characteristics (rural/urban) were not significantly related

with general satisfaction.

Among domains, the access and the quality showed

considerably high odds ratios, indicating their large impact

on general satisfaction (odd ratio: 11.65 for access, 14.41

for quality). In other words, if one is satisfied with the

service with respect to the access, then the likelihood for

the person to perceive general satisfaction positively

increases significantly. In addition to the access and qual-

ity, participation in treatment planning was shown to affect

one’s perception of general satisfaction (odds ratio: 2.69).

Discussion

The purpose of this study was to identify factors predicting

general satisfaction in community mental health center

services. Our analysis showed that the domains of access,

quality and participation in treatment planning were sig-

nificantly associated with general satisfaction. Previous

studies that examined predictors of patient satisfaction

reported similar findings. Jackson et al. (2001) examined

predictors of patient satisfaction in adults from a general

medicine walk-in clinic and found that patient-doctor

communication was one of the important predictors of

patient satisfaction. Sorlie et al. (2000) also observed a

significant association between the patient-doctor commu-

nication and patient satisfaction in their study. This is

consistent with our findings in which the domains of

quality and participation in treatment planning were sig-

nificant predictors of general satisfaction. More specifi-

cally, the domain of quality included questions about

whether the patient was educated with their treatment and

whether the staff respected the patient’s wishes about who

is and who is not to be given information about their

treatment. The domain of participation in treatment plan-

ning asked whether the patient played a central role in

deciding treatment goals. We believe that these findings are

clinically meaningful as the current health care provision is

92% 89% 94%82%

73% 74% 73%

0102030405060708090

100%

Pos

itiv

e R

espo

nse

Fig. 1 Percent positive response by domain

Table 3 Logistic regression predicting general satisfaction

General satisfaction Odds ratio P value

\Domain[Access 11.65* \0.001

Outcomes 1.75 0.120

Functioning 1.27 0.521

Participation in treatment planning 2.69* 0.001

Quality 14.41* \0.001

Social connectedness 1.75 0.050

\Region of residence[Urban (reference)

Rural 0.88 0.851

\Race[White (reference)

Black 1.41 0.470

American Indian 0.21* 0.003

Asian Dropped�

Hawaiian/Pacific Islander Dropped�

Other races 0.68 0.646

\Sex[Male (reference)

Female 1.55* 0.041

\Age[Age 18–30 0.83 0.497

Age 31–40 (reference)

Age 41–50 1.09 0.761

Age 51–60 1.26 0.532

Age 61–70 0.85 0.781

Age 71–80 0.18 0.112

Age [81 Dropped�

* Odds ratio is significant at 95 % confidence level� These variables are dropped from logistic regression model because

maximum likelihood estimation is impossible. That is, whenever

X = 1, Y = 1. This is probably because of small number of obser-

vation of the explanatory variable (Wooldridge 2005)

Community Ment Health J

123

moving towards the patient-centered care in which the

patient actively involves in their treatment process.

Understanding predictors of general satisfaction is

important because patient satisfaction has a substantial

impact on treatment compliance (Kane et al. 1997;

Mitchell and Selmes 2007a). Having good compliance is

essential for patients with chronic conditions, as it leads to

better health outcomes. However, it has been shown that

those with mental illness have particularly high drop-out

rates during the course of treatments, reflecting poor

engagement with their treatments (Mitchell and Selmes

2007b). This is further linked to increased risk of relapse

and hospital readmissions (Novick et al. 2010). Therefore,

much attention is needed for improving patient satisfaction

in mental health care. We believe that the findings of this

study provide useful insights about what factors affect

general satisfaction in mental health care services.

Some limitations should be noted when the findings of

this study are implemented. First, the samples selected in

this paper may not be a good representative of a general

population. For example, our study sample consisted of a

high proportion of white respondents. Although it was the

nature of the state where the survey was conducted, it is

certainly not the case in other states such as California or

New York. Therefore, one should be cautious when

applying the findings of this paper to a population with

different demographic characteristics. Second, our sam-

pling method could threat the validity of conclusions. We

used a convenient sampling method in which the subjects

were selected based on their convenient accessibility rather

than probability. Considering that our samples were

selected when they visited a CMHC, those who were dis-

satisfied and refused to visit a CMHC would have been

excluded. This could have a substantial impact on the

implication of our findings if the way of perceiving general

satisfaction is inherently different between CMHC visitors

and those who refuse to receive services from a CMHC.

Conclusion

The purpose of this report was to identify the factors that

predict ‘‘general satisfaction’’ with mental health services

in Kentucky CMHCs. Our analysis showed that responses

to general satisfaction were more associated with the

domains of access, quality, and participation in treatment

planning. We suggest that paying more attention to those

domains of service could positively influence mental health

care clients’ perception of general satisfaction.

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