As a consultant helping to evaluate mental health care programs, I am often challenged to assist providers in developing a definition of success for their program. Harder still is for a provider to identify a definition of success for a participant of their program. And the most challenging is often defining indicators of participant improvement toward success.

Let us consider the concept of ‘improvement’ as an incremental change which increases the likelihood of success (e.g., making more baskets in a basketball game) and the concept of ‘success’ as reaching a dichotomous outcome (e.g., winning or losing the game). However, there could be more than one type of success (e.g., playing a good defensive game and playing a good offensive game).

So, how do you know treatment is working in mental health and behavioral health care? Who determines success and how is it measured? These are difficult questions to answer in mental health and behavioral health care. I would be curious to hear the variety of way folks measure improvements in well-being.

When I was completing my dissertation at UC Berkeley, I was required to define what I meant by ‘well-being’. At the time, I stated that “a foundation of mental health is the capacity to carry out daily activities in a purposeful way in order to live a constructive and meaningful life which promotes well-being.” But, how is that measured?

There are a variety of assessments utilized in mental health care, but many focus on evaluating or diagnosing present state, not measuring changes over time. Improvement implies change, recovery implies change, and thus we should consider a measurement which is sensitive to change if we want to quantify improvement or identify success.

Perhaps we could consider change in function. Perhaps we could consider change in mood. What if function improves while mood declines or vice versa? What if someone seeks help for anxiety and sleep challenges and then reports improvements in sleep and reduction in anxiety but increase in alcohol use and anger? Is that an improvement? Like in the Sankey Diagram above, the energy may have shifted from one domain to another resulting in a greater probability to flow toward the same or a different outcome.

Many times in behavioral health, we set goals to identify success in treatment. If the first set of goals are achieved (e.g., sleep and anxiety) do we end care or adjust to set a new set of goals (e.g., alcohol use and anger)? If we achieve all goals, have we improved well-being?

Here are some questions to consider when thinking about how to measure improvement and define success in mental health and behavioral health care.

  1. Who defines well-being? The person in care or the provider or both?
  2. What is a definition of well-being? How is it broken into parts or domains?
  3. How would you measure improvement in well-being? What are the incremental steps on which one could improve?
  4. What are the definitions of success?

I would love to hear your thoughts and experiences.

Kate Cordell, PhD, MPH

Policy Fellow at Chapin Hall at the University of Chicago
Managing Director, Mental Health Data Alliance