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Measurement Based Care for Improving Mental Health
we take an in-depth look at mental health, explore the need for and value of measurement based care, examine behavioral health assessment tools and outline MBC implementation. Read the guide below or download your copy to take on the go.
In 2022, nearly 60 million people in the U.S.—just over 23%—were living with a mental illness, according to the National Institute of Mental Health. Unfortunately, only around half were receiving treatment. Still, as mental health disorders persist nationwide, more Americans are prioritizing wellness—over one-third have made a mental health-related resolution for 2025.
The key to getting more of those individuals through the doors of healthcare facilities and engaged in a successful mental health care plan is tools that support evidence-based practices and measurement based care (MBC). With proven techniques and data, providers can more easily earn patients’ trust, collaborate effectively with them and other clinicians and achieve more positive outcomes.
Read on as we take an in-depth look at mental health, explore the need for and value of measurement based care, examine behavioral health assessment tools, and outline MBC implementation.
Table of Contents
- Part 1: Need for Measurement Based Care
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Chapter 1: What is Mental Health? Definition and Key Concepts
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Chapter 2: Understanding the Role of Measurement Based Care (MBC) in Behavioral Health
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Chapter 3: Application of the Collaborative Care Model for Mental Health
- Part 2: Measurement Based Care: Tools Used During Treatment
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Chapter 4: Why Do Medical Providers Use Rating Scales?
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Chapter 5: How Mental Health Scales Work: An Example
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Chapter 6: Choosing the Right Measures
- Part 3: Putting Measurement Based Care into Practice
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Chapter 7: Measurement Based Care at the VA: How it Works
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Chapter 8: What to Consider When Implementing Outcome Measurement Tools
Part 1: Need for Measurement Based Care
Seeking support when you’re struggling to maintain positive mental health is a sensitive topic. Despite more public openness to discussing conditions in recent years, stigma and misinformation still stop many people who need care from consulting a professional.
Even those who do take that first step may still have cause for concern: Subjective interpretations of disorders and personal inputs from patients make assessments difficult and potentially problematic. So, how do you measure mental health and lay the groundwork for effective treatment? By grounding your providers with essential knowledge, then implementing measurement based care and a collaborative care model using time-tested behavioral health screening tools.
Chapter 1:
What is Mental Health? Definition and Key Concepts
Mental health is a state of wellbeing involving physical, emotional and social actualization, affecting how an individual acts, thinks and feels while helping them cope with everyday stress. As the healthcare industry increasingly adopts value-based care models, integrating treatment for both mental and physical health has become a priority.
According to the Centers for Disease Control and Prevention (CDC), you can have negative or positive mental health, but mental illness requires a diagnosis. Lifetime mental illnesses often take root early, with around half diagnosed by age 14 and nearly three-quarters by the age of 24, says the National Council of Mental Wellbeing.
However, diagnosis of some mental illness such as bipolar and mood disorders in young people is highly challenging, and those experiencing these conditions have a strong likelihood of facing learning difficulties, engaging in riskier behaviors and even enduring social exclusion. Left untreated, severe mental illness may have dire long-term consequences, including psychological impairment, a higher number of school dropouts and substance use, and incarceration.
While the causes of mental illnesses are unknown, psychological and environmental factors are major contributors. Biological factors include nerve cell pathways connecting specific brain regions, defects or injuries in particular brain areas, genetics and infections. Environmental factors might include loss of loved ones, neglect, social or cultural expectations, dysfunctional families and inability to relate to peers.
The most common mental disorders include depression, anxiety, bipolar disorder, schizophrenia and other psychoses, as well as obsessive-compulsive disorder (OCD).
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Chapter 2:
Understanding the Role of Measurement Based Care (MBC) in Behavioral Health
Let’s take a closer look at measurement based care (MBC). What is it? MBC is a way to track how effective a treatment is—whether it’s medication, a physical therapy approach, a surgical procedure, or a behavioral health intervention like transcranial magnetic stimulation (TMS).
To achieve a positive outcome in this field, MBC follows a process of care that includes:
- Behavioral health assessment (like a mental health screening)
- Diagnostic interviewing
- Diagnostic decision-making
- Treatment decision-making
- A series of monitoring events to ensure outcomes
MBC tracks and measures a patient’s improvement over time. Accuracy is vital when following a mental health care plan, especially when measuring behavioral change. As such, it’s important for patients not to miss appointments or fail to follow their doctor’s prescriptions.
For instance, when a patient regularly reports feeling much better after a therapy under MBC, the clinic may repeat the process for several weeks to achieve a clear outcome. When a patient doesn’t improve, the doctor might use the data collected to make evidence-based changes to prescribed medications and/or therapies. Again, patient participation and engagement are key; otherwise, how do you measure mental health with precision? If a patient feels unwell but fails to show up to follow-up appointments, there is no way to clearly determine an outcome and make necessary adjustments.
It’s important to note there are several challenges when using measurement based care, but the major one is health providers not applying the approach consistently to both behavioral health assessment and treatment. Uniformly using the method isn’t just a matter of frequency but also sequencing.
That said, when done properly, measurement based care benefits both the provider and the patient. Measurement-based practices contribute to clear and concise quantification of beginning point, progress and outcome, making it easier to communicate status among multiple providers and across care settings, which is critical in a collaborative care model.
Behavioral health screening tools and measurement solutions like mental health scales make evidence-based and more effective treatment possible. They help supply providers with the actionable intelligence they need to better collaborate with patients and their full clinical team on care and treatment to achieve positive mental health outcomes.
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Chapter 3:
Application of the Collaborative Care Model for Mental Health
The collaborative care model is a treatment method for mental illnesses that integrates mental and physical health care in a familiar setting. This care model helps address the wide gap in mental health treatment driven by financial barriers, therapy-seeking stigma and provider shortages. The treatment environment includes school-based facilities and primary care clinics, effectively taking mental health therapy where needed.
The collaborative care model entails interprofessional cooperation — healthcare experts working together to treat patients. Benefits of such collaboration include:
- Enhanced teamwork across departments, with psychiatrists, nurses, radiologists, social workers and other experts authorized to recommend patient care
- Increased payment incentive from the Centers for Medicare & Medicaid Services (CMS)
- Delivery of a more comprehensive mental health care plan, stemming from diverse medical and healthcare professionals working together
- Enhanced patient-care quality from the team effort made by expert professionals
- Improved communication
Having an array of healthcare professionals guiding a mental health care plan improves efforts to correlate and simultaneously treat mental and physical health conditions, from depression and anxiety to lung problems, cardiovascular disease, immunological function and physical pain. Some examples of collaborative care in mental health include:
- Accountable care
- Personalized team care
- Evidence-based care
- Population-based care
There are many promising approaches to how large care teams can implement measurement based care, and providers who pursue a collaborative care model benefit greatly from incorporating diagnostic tools like behavioral health assessment and mental health screening instruments, as well as check-ins like mental health scales to ensure consistent treatment progress. These aids offer objective, comparable data across care settings and patient populations over time.
When healthcare professionals, psychiatrists and therapists collaborate to provide treatment and assess patients’ progress over time, it effectively reduces treatment costs for minor to severe mental illness and creates the flexibility of offering services across multiple locations under different payment structures.
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Part 2: Measurement Based Care: Tools Used During Treatment
How do you measure mental health? Many providers in the behavioral health setting rely heavily on unstructured interviews to understand symptoms and guide treatment. But seeking information this way can be time-consuming. It might make it difficult to compare outcomes over time or across settings and yield unreliable information and data. Check-ins like mental health scales that support measurement based care can help overcome these and many other behavioral health challenges.
Chapter 4:
Why Do Providers Use Rating Scales?
Rating scales have several benefits in measurement based care, helping clinicians improve treatment for individual patients as well as broader patient populations. Most notably, they:
- Provide quantitative measurement of a patient’s experience;
- Offer consistent and comparable means to monitor individual progress over the course of a mental health care plan;
- Allow clinicians to identify when care interventions are or are not supporting positive mental health and hence recognize earlier when change may be needed;
- Enable research insights and identification of best practices by providing critical information;
- Facilitate the gathering and comparison of patient data at a population level;
- Organize population health data to inform payers about the value of care delivered at the system level; and
- Help providers use a measurement based care process to formulate a more precise care plan that targets both mental and physical health.
Three of the most common rating scales for behavioral health assessment are:
(MINI) Mini-International Neuropsychiatric Interview
The M.I.N.I. is available in several versions and assesses the most common diagnosed adult and pediatric mental health disorders, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). The standard version of the M.I.N.I. evaluates all mental health conditions, while condition-specific versions examine each disorder more specifically. Physicians use a flow chart to help determine which version of the mental health scale would be most appropriate for specific patients. The provider asks the patient a series of branching yes/no questions to establish the presence and frequency of symptoms. The standard M.I.N.I. interview takes about 15 minutes to complete when used digitally. (Paper administration takes around 35 minutes, and total time will vary depending on the patient’s answers.)
(SDS) Sheehan Disability Scale®
The SDS measures functional impairment across three domains: social, work/school and family life. It’s based on self-report using a 10-point scale from 0 to 10. Patients rate to what extent the symptoms they experience have disrupted their lives in five domains: not at all (0), mildly (1-3), moderately (4-6), markedly (7-9) and severely (10).
(S-STS) Sheehan-Suicidality Tracking Scale
The S-STS survey collects patients’ responses to 14 questions on a rating scale from 0 (not at all) to 4 (extreme). This mental health scale assesses severe mental illness through the seriousness of suicidal thoughts, intent, plans, hallucinations, impulses, preparatory behaviors and suicide attempts. The scale can be used as a clinician-administered rating scale or patient self-report to record ideation and behaviors.
Measurement based care and rating scales are increasingly improving the effectiveness of treatment planning, according to the American Psychological Association.
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Chapter 5:
How Mental Health Scales Work: An Example
To illustrate the power of using questionnaires and mental health scales in measurement based care, consider several applications related to body dysmorphic disorder (BDD). According to Cleveland Clinic, BDD is a disorder where preoccupation with an imagined or very slight defect with one’s body can affect an individual’s ability to attend school or work, or function in social or home settings. Using questionnaires and scales, clinicians assess and monitor the BDD patient's progress.
Screening
In the larger pantheon of behavioral health screening tools, the Body Dysmorphic Disorder Questionnaire (BDDQ) is a quick questionnaire that researchers and clinicians conduct to determine whether an individual has BDD. It assists in identifying patients who require further evaluation using the BDD Diagnostic Module. BDDQ versions cater to teens and adults. The questionnaires’ responses have no comparative element as opposed to rating scales, since they are either yes or no.
Assessment
Behavioral health assessment provides more detail, indicating the severity or frequency of symptoms. The Body Dysmorphic Disorder Diagnostic Module, also known as BDDD, evaluates appearance preoccupations and repetitive behaviors of clinical significance, identifies patients with either insight specifiers or muscle dysmorphia, and aids differentiation from an eating disorder. It’s based on the DSM-5 diagnostic criteria for BDD.
Monitoring
To identify changes in patient health with treatment, a clinician uses another type of mental health scale, such as the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS). BDD-YBOCS is used commonly to measure the progress of patients diagnosed with BDD. The scale has a series of 12 semi-structured items to assess the severity of BDD during the previous week and asks patients to respond to and rate items such as: “I check my appearance (e.g., in mirrors, by taking photos of myself or by touching with my fingers)” or “I avoid situations because of my appearance.”
The clinician can assess whether the patient’s health worsens or they experience more positive mental health when comparing data week over week. Tracking health over time — especially when the patient data is viewed across populations — aids clinicians and researchers in identifying which interventions support ideal outcomes and developing effective evidence-based practices.
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Chapter 6:
Choosing the Right Measures
Devising the right system for measurement based care in mental health treatment settings is challenging but vital for screening, behavioral health assessment and tracking of treatment progress. The proper measures aid researchers in identifying if an intervention is of value to particular populations. Data also helps decrease unwarranted variation in treatment and diagnosis, which, according to Wolters Kluwer, accounts for at least 25%, and possibly up to 65%, of the unnecessary costs in care delivery.
The Importance of Outcome Measures in Mental Healthcare: Key Things to Know
Successfully navigating the journey to positive mental health requires evidence that the work a patient and their clinicians put into the latter’s mental health care plan is effective. Process measures, while important, tell only a part of the story, focusing on actions performed at a given time but not the outcome. For instance, a patient process-measure could be taking medication, while a physician process-measure could be recording temperature or administering a blood test.
Outcome measures, on the other hand, explain the results of steps taken. Using behavioral health outcome measurement, a physician can determine the deterioration or improvement of patient conditions when changes occur and better ensure treatment has its intended effect. Data from outcome measures also helps with quality monitoring and tracking progress at the aggregate level.
How are Mental Health Outcomes Measured?
In behavioral health, outcome measurement indicates whether patients are improving due to treatment, and both patients and providers can track and report outcome measures. These are collected from patients through self-reporting, which typically involves form completion. Results are called “patient-reported outcomes measures (PROMs)” or “patient-reported symptom rating.” According to the National Institutes of Health (NIH), mental health outcome measures must be reliable and valid, sensitive to change, comparable across relevant client service types and groups, and meaningful to clinicians and their clients.
A wide range of mental health outcome measures helps gauge the patient’s mental wellness. Some standard measures in behavioral health include cognitive performance, physical and social activity and behavioral experiences.
An outcome-based approach to mental health is beneficial to providers, patients, healthcare systems and society in several ways. It:
- Enables providers to track and monitor potential patient backsliding and improvements
- Offers meaningful insights into the patient’s state of mind
- Assesses clinical effectiveness of the healthcare system and providers
- Demonstrates desired changes occurring from a patient’s perspective
- Helps procure funding and support payment
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Part 3: Putting Measurement Based Care Into Practice
Healthcare providers routinely use measurements to determine physical health. However, despite its many benefits, measurement based care has not yet been widely adopted for mental health screening, behavioral health assessment and ensuing treatment planning: In a recent survey, only 46% of behavioral health care providers reported using MBC with at least half their patients. What’s more startling, according to Psychiatric Online, is that only 18% of psychiatrists and 11% of psychologists apply a rating system during their routine mental healthcare practices. This seems largely due to a lack of knowledge about MBC’s clinical efficacy.
Yet despite infrequent use in behavioral health, measurement based care is a proven, powerful tool to support more positive mental health outcomes. One of the more notable projects where it's impacting mental health outcomes is within the nation’s most extensive integrated healthcare system: the Veterans Health Administration, a U.S. Department of Veterans Affairs (VA) component.
Chapter 7:
Measurement Based Care at the VA: How it Works
The VA has been rolling out measurement based care principles to establish a standard for behavioral health treatment planning and setting recovery goals.
Behavioral health-focused MBC at the VA uses a “collect, use and share” foundation that works as described below:
When the VA initiated its MBC in mental health initiative, an interagency task force on veterans and military agreed to a pilot of four measures for the measurement based care program. Those are:
- (PCL-5) PTSD Symptom Checklist for PTSD assessment
- (BAM-R) Brief Addiction Monitor for substance use and risk together with recovery factors assessment
- (PHQ-9) Patient Health Questionnaire for depression assessment
- (GAD 7) Generalized Anxiety Disorder for anxiety assessment
After the pilot, the VA conducted a survey comprising 230 mental health providers across nearly 50 VA medical centers. The study aimed to assess attitudes and self-reported use of various measurement based care components like behavioral health screening tools and mental health scales. The adoption of the MBC tools at the VA was high: about 58% of the providers recorded collecting at least one measure for at least half of their patients and provided positive feedback.
The survey revealed high treatment planning acceptance, with 72% indicating that they always explained their results to the patients while 65% used the results as part of shared decision-making. However, only 37% indicated using scores when discussing a patient with another healthcare provider.
The authors of the VA pilot program study note measurement based care using patient-reported data shows better outcome measures for patients with mental illness, from better engagement to faster response to treatment. Yet, despite these benefits of MBC and the availability of validated measures for use by mental health practitioners, the approach is still adopted less than in other clinical areas.
The VA also acknowledges that the adoption of measurement based care is lower in mental healthcare because it is a “pretty big adjustment” in clinical practice. As a result, the VA is rolling out MBC in phases to study the best ways to put it into practice.
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Chapter 8:
What to Consider When Implementing Outcome Measurement Tools
Of course, implementing outcome measures alone does not improve patient care. Rather, clinicians must establish the infrastructure to guide usage. Here are some tips on how you can better implement measurement based care within your organization:
- Use digital solutions; for instance, you can screen, assess and track patients more seamlessly using software programs
- Incorporate an outcome-measures approach in communicating progress
- Integrate process improvement consistently to make collaboration on patient health decisions easier
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Find the Best Measurement Based Care Tools for Your Needs in One Place
Achieving better nationwide mental health depends heavily on the ability of providers to offer trusted, effective care that leads to positive outcomes. Adopting measurement based care is crucial to ensuring that individuals who walk through a behavioral health facility’s doors are monitored at all stages of their treatment journey, feel empowered by the progress they see and have their full care team united in support of the same goals.
Proem provides a variety of tools for incorporating measurement based care into behavioral health practice. Our licensed tools support data collection to track each patient’s health journey and demonstrate outcomes for providers, payers and researchers.
Read more about our licensed tools and reach out today to hear how we can help position your practice for data-backed success.
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