Featured Article
Article Title
Measuring patient satisfaction with mental health services in correctional settings: a systematic scoping review
Authors
Roland M. Jones - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Psychiatry Department, University of Toronto, Toronto, ON, Canada
Niroshini Mather - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
M. Umer Waqar - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
Madleina Manetsch - Forensic Psychiatric Clinic, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
Chloe Taylor - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
Vito Adamo - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
Marco Kilada - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
Cory Gerritsen - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Psychiatry Department, University of Toronto, Toronto, ON, Canada
Alexander I. F. Simpson - Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Psychiatry Department, University of Toronto, Toronto, ON, Canada
Abstract
Introduction: The measurement of patient satisfaction with mental health services is well-established and a key indicator of performance. Patient satisfaction with mental health services received in criminal justice settings however is however less frequently studied. Our aim was to establish how frequently patient satisfaction with mental health services in correctional (prison) settings is being reported, and to identify methods of measurement including all tools that have been used to measure patient satisfaction in these settings.
Methods: A comprehensive search of published articles and thesis dissertations was undertaken using multiple databases. Two reviewers independently screened the references to determine eligibility and then extracted the necessary data using a predefined extraction template. Only studies that measured patient satisfaction with a mental health service or intervention within a correctional facility were included.
Results: 46 studies, which included various measures, were identified as being eligible for inclusion. The median number of patients involved in these studies was 37.5 (range: 4–1150). Tools were heterogeneous in length, purpose, and design, and these measured a variety of different domains. Most of the tools used had been developed in non-correctional settings and applied in correctional settings without adaptation. Tools with established psychometric properties were used only in ten instances, whereas the majority of the studies reported using author-developed interviews and questionnaires to obtain feedback.
Conclusion: Patient satisfaction measurement tools in correctional services are heterogeneous and largely unvalidated; there is no uniformity in the measurement methods used.
Methods: A comprehensive search of published articles and thesis dissertations was undertaken using multiple databases. Two reviewers independently screened the references to determine eligibility and then extracted the necessary data using a predefined extraction template. Only studies that measured patient satisfaction with a mental health service or intervention within a correctional facility were included.
Results: 46 studies, which included various measures, were identified as being eligible for inclusion. The median number of patients involved in these studies was 37.5 (range: 4–1150). Tools were heterogeneous in length, purpose, and design, and these measured a variety of different domains. Most of the tools used had been developed in non-correctional settings and applied in correctional settings without adaptation. Tools with established psychometric properties were used only in ten instances, whereas the majority of the studies reported using author-developed interviews and questionnaires to obtain feedback.
Conclusion: Patient satisfaction measurement tools in correctional services are heterogeneous and largely unvalidated; there is no uniformity in the measurement methods used.
Keywords
patient satisfaction, correctional psychiatry, forensic psychiatry, scoping review, mental health, incarceration
Summary of Research
“Satisfaction is a multidimensional concept [that] broadly reflects the patients’ subjective evaluation of the care they received… International standards [require] that people who are incarcerated should receive health care that is at least equivalent to those who are not incarcerated", however, the quality of healthcare often falls below acceptable standards.
The development of clinical service tools for evaluating quality of correctional mental health services has lagged behind other healthcare services. Systematic measurement of patient satisfaction is essential to capture the experiences and perspectives of this population and to incorporate them into service improvement efforts. Although correctional facilities present unique challenges for mental health service provision, patient feedback should be integral as one facet of measuring the adequacy of the service…
Our aim was to establish (1) how frequently patient satisfaction with mental health services is reported; (2) identify the methods used to assess patient satisfaction, and (3) identify all published tools used to measure patient satisfaction in these settings, including their psychometric properties, and any evidence of replication or validation” (p. 2).
“We considered all literature published in any year in English until the final search date on 1 August 2024… The literature reviewed included primary research studies published in a peer-reviewed journal and thesis dissertations… Abstracts that met the aforementioned eligibility criteria were subjected to a full-text screening by the same reviewers, and eligible studies were retained… 85 papers were subjected to a full text review and 46 studies were eligible for inclusion…
Eight of the ten studies were conducted exclusively within a correctional setting, and two studies additionally involved community corrections programs. Only two studies evaluated correctional mental health services overall, two studies assessed telepsychiatric services, and the remaining six evaluated specific mental health programs, such as a program designed for borderline personality disorder (STEPPS) and psychotherapy” (p. 3).
“There were 15 studies which had developed questionnaires specifically for the site that they were evaluating and had not been replicated in other settings. Of these studies, eight were conducted in the USA, three in the UK, two in Canada, one in Australia, and one in Greece. Five studies evaluated satisfaction with correctional mental health services overall; three of these focused on telepsychiatric services. Nine focused on specific programs including counseling services, cognitive behavioral therapy, peer support programs, a stress reduction program, and a parenting program. A single study evaluated patient satisfaction with two different nurse practitioner models. The sample sizes varied, ranging from 8 to 418. The surveys addressed domains such as helpfulness, expectations, perceived effectiveness, recommendation, promptness, and overall service satisfaction” (p. 4).
“Main findings…:
- Morgan et al. (2008) Client Satisfaction Questionnaire (CSQ-8) Prison [-] US [-] 186 [-] Telemental health for parolees. Questionnaire [-] Not reported.
No difference in satisfaction between face-to-face and telemental health visit…
- Brodey, et al. (2000) Group Health Association of America Consumer Satisfaction Survey. Prison [-] US [-] 43 [-]
Satisfaction with telemental health psychiatric versus in person evaluation. Questionnaire 97% Satisfaction with telemental health evaluation was high and similar to in-person evaluations” (p. 5- 6).
“First, very few studies have measured patient satisfaction in correctional settings overall. There were 46 studies identified in the entire literature in English, and most were very small indicating this is a much overlooked area of inquiry given the size of the population receiving mental health services in correctional settings.
Second, only two different psychometrically validated tools have been reported (CSQ-8 and POPEQ) and neither had been designed specifically for use in correctional settings.
Third, the majority of studies had used study-specific (ad-hoc) surveys or interviews to evaluate satisfaction for a particular group or intervention which had not been validated. None of the study specific measures demonstrated psychometric properties required for widespread dissemination.
Fourth, while patient satisfaction is a multidimensional concept, the only tools validated in correctional settings to date have unidimensional structures. This suggests that important dimensions of patient satisfaction relevant to correctional settings may not be adequately captured by existing tools” (p. 6).
“Dissatisfaction with correctional mental health services was more readily apparent in studies which adopted a qualitative methodology. This may be attributed to the open format of an interview, which enables participants to contextualize their experiences and to express views that may not emerge from structured surveys” (p. 7).
“The results of this review emphasize the need for correctional-specific tool development and validation in correctional settings, to regularly gauge patient satisfaction and implement measures to improve service delivery when deficiencies are identified” (p. 12).
The development of clinical service tools for evaluating quality of correctional mental health services has lagged behind other healthcare services. Systematic measurement of patient satisfaction is essential to capture the experiences and perspectives of this population and to incorporate them into service improvement efforts. Although correctional facilities present unique challenges for mental health service provision, patient feedback should be integral as one facet of measuring the adequacy of the service…
Our aim was to establish (1) how frequently patient satisfaction with mental health services is reported; (2) identify the methods used to assess patient satisfaction, and (3) identify all published tools used to measure patient satisfaction in these settings, including their psychometric properties, and any evidence of replication or validation” (p. 2).
“We considered all literature published in any year in English until the final search date on 1 August 2024… The literature reviewed included primary research studies published in a peer-reviewed journal and thesis dissertations… Abstracts that met the aforementioned eligibility criteria were subjected to a full-text screening by the same reviewers, and eligible studies were retained… 85 papers were subjected to a full text review and 46 studies were eligible for inclusion…
Eight of the ten studies were conducted exclusively within a correctional setting, and two studies additionally involved community corrections programs. Only two studies evaluated correctional mental health services overall, two studies assessed telepsychiatric services, and the remaining six evaluated specific mental health programs, such as a program designed for borderline personality disorder (STEPPS) and psychotherapy” (p. 3).
“There were 15 studies which had developed questionnaires specifically for the site that they were evaluating and had not been replicated in other settings. Of these studies, eight were conducted in the USA, three in the UK, two in Canada, one in Australia, and one in Greece. Five studies evaluated satisfaction with correctional mental health services overall; three of these focused on telepsychiatric services. Nine focused on specific programs including counseling services, cognitive behavioral therapy, peer support programs, a stress reduction program, and a parenting program. A single study evaluated patient satisfaction with two different nurse practitioner models. The sample sizes varied, ranging from 8 to 418. The surveys addressed domains such as helpfulness, expectations, perceived effectiveness, recommendation, promptness, and overall service satisfaction” (p. 4).
“Main findings…:
- Morgan et al. (2008) Client Satisfaction Questionnaire (CSQ-8) Prison [-] US [-] 186 [-] Telemental health for parolees. Questionnaire [-] Not reported.
No difference in satisfaction between face-to-face and telemental health visit…
- Brodey, et al. (2000) Group Health Association of America Consumer Satisfaction Survey. Prison [-] US [-] 43 [-]
Satisfaction with telemental health psychiatric versus in person evaluation. Questionnaire 97% Satisfaction with telemental health evaluation was high and similar to in-person evaluations” (p. 5- 6).
“First, very few studies have measured patient satisfaction in correctional settings overall. There were 46 studies identified in the entire literature in English, and most were very small indicating this is a much overlooked area of inquiry given the size of the population receiving mental health services in correctional settings.
Second, only two different psychometrically validated tools have been reported (CSQ-8 and POPEQ) and neither had been designed specifically for use in correctional settings.
Third, the majority of studies had used study-specific (ad-hoc) surveys or interviews to evaluate satisfaction for a particular group or intervention which had not been validated. None of the study specific measures demonstrated psychometric properties required for widespread dissemination.
Fourth, while patient satisfaction is a multidimensional concept, the only tools validated in correctional settings to date have unidimensional structures. This suggests that important dimensions of patient satisfaction relevant to correctional settings may not be adequately captured by existing tools” (p. 6).
“Dissatisfaction with correctional mental health services was more readily apparent in studies which adopted a qualitative methodology. This may be attributed to the open format of an interview, which enables participants to contextualize their experiences and to express views that may not emerge from structured surveys” (p. 7).
“The results of this review emphasize the need for correctional-specific tool development and validation in correctional settings, to regularly gauge patient satisfaction and implement measures to improve service delivery when deficiencies are identified” (p. 12).
Translating Research into Practice
“Few studies described the regular use of satisfaction surveys or how satisfaction data have been translated into actionable changes for mental health service delivery and quality improvement. Reporting such experiences could reinforce the utility of satisfaction tools and provide valuable insights into the ongoing development of correctional mental health care provision. Communication of this purpose could help promote a more patient-centered approach addressing concerns that have been highlighted in numerous studies… For correctional populations, ensuring anonymity during data collection and dissemination is essential, considering patients’ fears of stigma and criticism from disclosure” (p. 7).
Other Interesting Tidbits for Researchers and Clinicians
- “Karachaliou et al. (2024) Questionnaire [-] Prison [-] Greece [-] 100 Telepsychiatry Services Questionnaire
Higher satisfaction observed with telepsychiatry services vs face-face services…
- Mekhjian et al. (1999) Questionnaire [-] Prison [-] US [-] 299 [-] (23 psychiatry) General telemedicine in correctional setting (includes psychiatric services) [-] Questionnaire
Overall, patients were satisfied with telemedicine, specifically its role in information exchange and patient comfort…
- Magaletta et al. (2000) Questionnaire [-] Prison [-] US [-] 75 [-] Telehealth (psychiatrist consultations) [-] Questionnaire
Overall, patients had a positive rating of the telehealth program…
-Burton et al. (2021) Informal feedback [-] Prison [-] US [-] Correctional mental health services…
Patients’ informal feedback reflects relatively high overall satisfaction with telepsychiatry” (p. 8- 10).
“There is currently no standardized or widely accepted method for measuring patient satisfaction measurement with the mental health services in correctional settings. While adapting tools developed in non-correctional settings is a reasonable step, validation is required for use in correctional settings” (p. 12).
Higher satisfaction observed with telepsychiatry services vs face-face services…
- Mekhjian et al. (1999) Questionnaire [-] Prison [-] US [-] 299 [-] (23 psychiatry) General telemedicine in correctional setting (includes psychiatric services) [-] Questionnaire
Overall, patients were satisfied with telemedicine, specifically its role in information exchange and patient comfort…
- Magaletta et al. (2000) Questionnaire [-] Prison [-] US [-] 75 [-] Telehealth (psychiatrist consultations) [-] Questionnaire
Overall, patients had a positive rating of the telehealth program…
-Burton et al. (2021) Informal feedback [-] Prison [-] US [-] Correctional mental health services…
Patients’ informal feedback reflects relatively high overall satisfaction with telepsychiatry” (p. 8- 10).
“There is currently no standardized or widely accepted method for measuring patient satisfaction measurement with the mental health services in correctional settings. While adapting tools developed in non-correctional settings is a reasonable step, validation is required for use in correctional settings” (p. 12).
Additional Resources/Programs
As always, please join the discussion below if you have thoughts or comments to add!
- Pushing the Ball Forward, Faster: Using the COVID-19 Pandemic to Expand Forensic Telehealth
- How COVID-19 Changed the Landscape of Forensic Evaluations: The Utility and Future of Telehealth in Examinations
- Ethical Practice During the COVID-19 Pandemic – Limitations and Adaptations to Telehealth with Dee Ray and Lee Kinsey
- Online Counseling and Telemental Health – A Conversation with Telehealth Certification Institute’s Ray Barrett
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