The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ), is requesting approval for a revision to the National Mental Health Services Survey (N-MHSS) (OMB No. 0930-0119) which expires on February 28, 2017. This requested revision seeks approval for an abbreviated N-MHSS-Locator Survey instrument for data collection in 2017 and 2019 (Attachment A.1), a full-scale N-MHSS instrument for data collection in 2018 (Attachment A.2), and for the Between-Survey Updates in 2017, 2018, and 2019 (Attachment A.1).
The N-MHSS provides national and state-level data on the number and characteristics of mental health treatment facilities in the United States. This data collection is authorized by Section 505(b) [42 USC 290aa—4] of the Public Health Service Act which mandates the collection of data on the number and variety of public and private nonprofit mental health programs and persons who receive care from them.
As background, the U.S. government has been collecting information on mental health services since 1840. From 1840 to 1946, the U.S. Bureau of the Census collected mental health services information. Following the creation of the National Institute of Mental Health (NIMH) in 1946, the present-day Department of Health and Human Services (HHS) continued the collection of information on mental health services from 1947 through 1968. The series of surveys to collect mental health services information, through the Inventory of Mental Health Organizations (IMHO), began in 1969 under the direction of NIMH. Responsibility for the IMHO was transferred to SAMHSA at the time of its creation in 1992. Renamed the National Survey of Mental Health Treatment Facilities in 2008, and the National Mental Health Services Survey in 2010, this series of specialty mental health provider surveys has existed, in one form or another, for the past 44 years. Since 1969, the goals and content of this data collection effort have been fairly consistent: obtaining basic data on the number and types of specialty mental health service providers, their characteristics and the services they provide. This data collection effort is part of the longest continuous series in American public health and is the only mechanism for obtaining national and state-level data about the specialty mental health care delivery system.
The next cycle of the N-MHSS in 2017 will serve to update the mental health component of SAMHSA’s online Behavioral Health Treatment Services Locator available at http://findtreatment.samhsa.gov. The last complete update of the Locator was based on information collected in the 2015 N-MHSS-Locator Survey, an abbreviated version of the survey. Additional updates to the Locator were made during the N-MHSS update activity conducted on a rolling basis in 2016. CBHSQ plans to conduct the abbreviated N-MHSS-Locator Survey to collect only the information needed to update the online Locator in Spring 2017 and Spring 2019. CBHSQ plans to conduct a full-scale N-MHSS in Spring 2018. The full-scale N-MHSS will collect not only information needed to update the Locator, such as facility location, organizational characteristics, and services/ programs provided, but also information on service utilization. This cycle of alternating years of full and abbreviated data collection will assure that data on the Locator will be continually updated. In addition, CBHSQ plans to maintain a continuous mechanism to add new facilities that are identified between regular survey cycles to the Locator. This survey will be known as the N-MHSS Between-Survey Update. Both the Locator Survey and the Between-Survey Update will use the same abbreviated N-MHSS-Locator Survey instrument.
The purpose of the N-MHSS continues to be the collection of information about mental health treatment service providers across the nation and the services they provide to persons with mental illness. Most importantly, the data derived from the survey will be used to populate SAMHSA’s online Behavioral Health Treatment Services Locator, a free online tool that persons nationwide, including mental health consumers, family members, and behavioral health professionals, can use to locate mental health treatment facilities in their area that provide the particular type(s) of mental health treatment services and other facility-based services that individuals are seeking.
To meet the need for a comprehensive and current enumeration of mental health facilities throughout the nation, the N-MHSS must be fielded each year to provide the database for SAMHSA’s online Locator. The database for the online Locator will include facility-level information, such as type of facility; what entity owns/operates the facility; selected services offered by the facility; types of payment accepted; specially-designed programs offered; languages in which services are provided; availability of services for the hearing-impaired; and basic contact information so that the individual can schedule an appointment.
SAMHSA/CBHSQ will also use the information collected from the N-MHSS to update SAMHSA’s Inventory of Behavioral Health Services (I-BHS). The I-BHS is the database of all specialty mental health and substance abuse treatment facilities known to SAMHSA. In turn, the I-BHS will provide the survey frame for the N-MHSS and a sampling frame of substance abuse and mental health treatment facilities for other potential national surveys.
In addition to collecting information about the characteristics of the treatment service
location, the full-scale N-MHSS will collect facility-level information on treatment service
utilization including the number of clients served on the survey reference data (one-day
census count) and the demographic characteristics of these clients. This information is critical to
meet the needs of: (a) policymakers at the national and state levels for current data on the
availability and utilization of mental health services for budgeting, planning, and research; (b)
mental health facilities themselves for their program-planning efforts; (c) university researchers
and national health-related companies for determining the need for service providers (access to
care) in underserved areas; and (d) the U.S. Congress or offices within HHS which make
periodic data requests for statistics, such as number of psychiatric beds or number of persons by
legal status (i.e., voluntary treatment or involuntary commitment).
The N-MHSS database also provides a valuable resource tool for the general public who visit
the websites of other HHS offices and national professional organizations/associations, for
example, the NIMH at http://nimh.nih.gov/health/find-help/index.shtml; the Office of Adolescent
Health (OAH) at http://www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/; and
Mental Health America at http://www.mentalhealthamerica.net/go/find_therapy.
In addition to SAMHSA publications, data derived from the N-MHSS will be published in the National Center for Health Statistics’ (NCHS) Health, United States, and in the World Health Organization’s (WHO), Department of Mental Health and Substance Abuse, Mental Health Atlas.
The N-MHSS questionnaire consists of three sections: Facility Characteristics (Section A), Client/Patient Count Information (Section B), and General Information (Section C). For this cycle, the 2017 and the 2019 N-MHSS-Locator Survey will ask only Sections A and C. The 2018 full-scale N-MHSS will ask the three sections. The N-MHSS-Locator Survey questionnaire is an abbreviated version of the full-scale questionnaire.
Based on feedback from telephone interviewer debriefings, the question on providing treatment services in sign language will include some instructions to clarify the content of the question. This change will be consistent with what is currently used in a similar question on the SAMHSA’s National Survey of Substance Abuse Treatment Services (N-SSATS). Another change to the questionnaire is the elimination of the question asking if the facility had a National Provider Identification (NPI) number. The original intention to have this question is no longer applicable to the N-MHSS.
The N-MHSS will use multiple technologies and applications in order to minimize respondent burden and improve the quality of the data collected. These include a web-based, self-administered survey; computer-assisted telephone interviewing (CATI); an automated data entry program; and a centralized database application that maintains survey frame information and manages the data collection modes (web, paper, CATI), simultaneously. The web screens for the 2017 and 2018 online surveys are included as Attachments A.3 and A.4, respectively, and a CATI questionnaire is included as Attachment A.5.
The N-MHSS will use the latest technology for all data collection applications:
Facility Tracking and Data Editing System (F-TADES), a specially developed application that will store and organize facility information, manage and monitor survey progress, and field multiple data collection modes simultaneously for the survey
WebServ 2, an SQL 2008R2 ASP.NET application for developing the web survey
Visual Studio.Net 2013 for creation of the Internet pages
Blaise 4.8 to create computer-assisted telephone interviews
SAS 9.4 for the production of all data files
The N-MHSS will be offered in multiple modes, including a web version that respondents can log onto using a unique user ID and password assigned to their facility. Based on preliminary results of the full-scale 2016 N-MHSS and SAMHSA’s National Survey of Substance Abuse Treatment Services (N-SSATS) (OMB No. 0930-0106), it is expected that approximately 90 percent of all respondents will choose to complete the survey online. Facilities that choose to use the Internet will be assisted by data validations that are built into the WebServ2 program, as well as programmed skip patterns. Web respondents will be able to move back and forth in the survey and edit their responses and suspend the survey and come back to the same point in the questionnaire at a later time.
The N-MHSS will also use Blaise CATI to collect data from facilities that do not respond by web or mail. In addition, Blaise will support the scheduling, monitoring, and documentation of all telephone calls made to the respondent. The N-MHSS will include an informational website for facilities that contains the questionnaire, as well as all definitional and instructional material. It also will include links to related SAMHSA sites, a description of the study and its goals, and a link to view current response rates by state.
The N-MHSS is the only data collection that provides a comprehensive database of all known mental health treatment facilities throughout the U.S. No other federal agency or private organization collects information about the types of public and nongovernmental facilities that comprise the behavioral health care service delivery system on a state and national level. The information on mental health facilities already available from other data collection efforts cannot be used because the scope of coverage is limited or available data typically are outdated and not standardized across types of facilities. For example, the American Hospital Association (AHA) collects limited information on psychiatric hospitals in its annual survey of hospitals. However, neither the scope of coverage nor the data collected are in the detail required by SAMHSA for use by the public seeking to find treatment through the online Locator.
No other national organization or federal agency collects standardized information on mental health treatment services across particular types of mental health facilities, such as outpatient mental health centers, residential treatment centers for children, and multi-setting community mental health facilities.
CBHSQ also collects data on substance abuse treatment facilities through the National Survey on Substance Abuse Treatment Services (N-SSATS). However, the data collected focuses on substance abuse treatment services. The N-MHSS will complement and not duplicate the information collected through the N-SSATS.
The N-MHSS involves small entities. The following methods will be used to minimize reporting burden for small entities in particular and for all respondents in general:
The surveys are designed to collect the absolute minimal amount of information required for the intended use of the data.
The use of Internet technologies provides respondents the opportunity to easily complete a web-based, self-administered survey that will decrease the time between data collection and error resolution since the web survey will automatically check responses for errors, such as inconsistent responses, and will automatically follow the proper skip patterns to display the next appropriate question based on the respondent’s previous response(s).
Computer-assisted telephone interviewing (CATI) will be implemented for respondents who do not wish to or cannot respond on the web.
All of the instructions for each question are included with the question rather than on a separate instruction page. This saves the respondent the time and trouble of turning pages between the questionnaire and an accompanying instruction manual.
An informational website that includes the survey’s purpose and definitions of key terms will be set up for respondents. This will allow those responding on the Internet to have the survey and the definitions open simultaneously in their web browser.
Contractor staff will be available, via a toll-free telephone helpline and an e-mail helpdesk to answer any questions that respondents may have regarding the N-MHSS.
If the requested information is not collected, federal program activities will suffer in several ways. First, SAMHSA will not be following what is stipulated in Section 505(b) [42 USC 290aa—4] of the Public Health Service Act. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on the nation’s communities through policies and programs that build resilience and facilitate recovery. One way that SAMHSA advances this mission is by making available to the public an online tool – SAMHSA’s Behavioral Health Treatment Services Locator which enables mental health service consumers, their families and mental health professionals to find appropriate mental health care in their area. The usefulness of the Locator is directly related to the completeness and accuracy of the information it contains; thus, an annual N-MHSS with continuous data collection from newly identified facilities and updates relative to facilities that have closed or merged is essential for maintaining a high quality, up-to-date treatment facility locator.
The full-scale N-MHSS is only conducted every other year to reduce burden. If the proposed N-MHSS is not conducted or conducted less frequently, critical information about mental health treatment services offered to consumers in need of such services will not be available to this most vulnerable segment of the nation’s population. Data on the numbers and characteristics of persons treated in these specialty mental health facilities will be outdated and unavailable to the behavioral health services research community, national health provider organizations, and the states in need of such data to measure the volume of service utilization to meet the needs of policymakers and program planners for financial and human resource allocation. Finally, in conjunction with data in the I-BHS, the information collected in the N-MHSS will provide the survey frame for periodically conducted specialized surveys of mental health service providers and persons served.
This data collection complies fully with 5 CFR 1320.5(d)(2).
A Federal Register notice was published on September 27, 2016 (81 FR 66287). No public comments were received.
Natalie Wilkins, Ph.D.
Behavioral Scientist
Centers for Disease Control and Prevention (CDC)
Atlanta, GA
Email: [email protected]
Sara Azimi-Bolourian, Ph.D.
Project Officer
Bureau of Health Workforce
Health Resources and Services Administration (HRSA)
Rockville, MD
Email: [email protected]
Marc Zodet, M.S.
Senior Health Statistician
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality (AHRQ)
Rockville, MD
Email: [email protected]
No payment or gifts are provided to respondents for participation in the N-MHSS.
A Pledge to Respondents completing the N-MHSS is included on the last page of the survey instrument. This pledge states that the information provided will be protected to the fullest extent allowable under Section 501(n) of the Public Health Service Act (42 USC 290aa(n)) – Limitation on the Use of Certain Information. This law permits the public release of identifiable information about an establishment only with the consent of that establishment and limits the use of information to the purposes for which it was supplied. With the explicit consent of eligible treatment facilities, information provided in response to survey questions will be published in SAMHSA’s online Behavioral Health Treatment Services Locator.
The N-MHSS does not include questions of a sensitive nature.
The estimated annual burden for the N-MHSS is detailed in the following tables:
TABLE 1. Estimated Total Burden for the N-MHSS
|
|||||||
Facility Respondent
|
Number of Respondents |
Responses per Respondent |
Total Responses |
Hours per Response |
Total Burden Hours |
Wage Rate |
Total Hourly Cost |
Facilities in 2017 N-MHSS-Locator Survey universe
|
17,000 |
1 |
17,000 |
0.42 |
7,140 |
$45.43 |
$324,370
|
Facilities in Between-Survey Update, 20171
|
1,700 |
1 |
1,700 |
0.42 |
714 |
$45.43 |
$32,437 |
Facilities in 2018 N-MHSS universe
|
17,000 |
1 |
17,000 |
0.75 |
12,750 |
$45.43 |
$579,233 |
Facilities in Between-Survey Update, 20181
|
1,700 |
1 |
1,700 |
0.42 |
714 |
$45.43 |
$32,437 |
Facilities in 2019 N-MHSS- Locator Survey universe
|
17,000 |
1 |
17,000 |
0.42 |
7,140 |
$45.43 |
$324,370
|
Facilities in Between-Survey Update, 2019 1
|
1,700 |
1 |
1,700 |
0.42 |
714 |
$45.43 |
$32,437 |
Total |
18,700 |
|
18,700 |
|
29,172 |
|
$1,325,284 |
Average Annual Total
|
18,700 |
|
18,700 |
|
9,724 |
|
$441,761 |
1 Throughout the year, approximately ten percent of facilities close or merge and a similar number of new facilities are identified.
TABLE 2. Summary of Estimated Annual Burden for the N-MHSS
|
||||
Facility Respondent |
Number of Respondents
|
Responses per Respondent |
Average Hours per Response |
Total Burden Hours |
|
|
|
|
|
|
|
|
|
|
Facilities in N-MHSS-Locator Survey universe in 2017 and 2019
|
17,000 |
|
|
4,760 |
Newly identified facilities in Between-Survey Update in 2017, 2018, and 20191, 2
|
1,700 |
|
|
714 |
Facilities in N-MHSS universe in 2018
|
17,000 |
|
|
4,250 |
Average Annual Total
|
18,700 |
|
|
9,724 |
1 Throughout the year, approximately ten percent of facilities close or merge and a similar number of new facilities are identified.
2 Collection of information on newly identified facilities throughout the year, as they are identified, so that new facilities can quickly be added to the Locator.
Basis for Burden Hour Estimate:
Based on documentation available from the results of the 2010 and 2014 web-based surveys, the time to complete the survey online was an average of 35 minutes. An estimated 10 minutes has been added to the 35 minutes to reflect the additional time required to search existing data sources to report the client counts and demographic information.
The N-MHSS-Locator Survey questionnaire is an abbreviated version of the full-scale
N-MHSS questionnaire. Based on reductions in the size of the survey instrument (total number of pages and questions), and prior field experience in the fielding of the 2012 and the 2015 N-MHSS-Locator Surveys, the estimated time for response to the N-MHSS-Locator Survey questionnaire is 25 minutes (0.42 hours).
Basis for Hourly Wage Rate Estimate:
The estimated hourly wage rate is based on the median hourly pay of $45.43 for medical and health service managers as reported in the Bureau of Labor Statistics, U.S. Department of Labor Occupational Outlook Handbook, 2016-17 Edition, Medical and Health Service Managers, at http://www.bls.gov/ooh/management/medical-and-health-services-managers.htm.
The annualized cost to the Government for the N-MHSS component of the SAMHSA/ CBHSQ data collection contract is estimated to be $2,750,000. The N-MHSS contract-related activities included in this estimate are described below. The total annualized cost to the Government including the contract monitoring activities of one FTE is estimated to be $3,110,000.
Data Collection, Data Processing and Creation of Merged Data File. These activities include creation, maintenance and security of an informational and survey website available to facility respondents during the active data collection period; operation of a toll-free telephone helpline; development of all data collection materials and instruments; mail out of survey materials to facilities including costs for postage, envelopes, printing, processing, and handling; development of editing procedures and procedures for maximizing web questionnaire response rates; development and implementation of a system for tracking and monitoring response status throughout the data collection period; development of procedures for administering the questionnaire via CATI to facilities that have failed to respond by web, including questionnaire development and programming, and interviewer training; development of a tracking system for weekly reporting of data collection progress and status; development of machine cleaning specifications; and creation of a data file.
Preparation of Annual Summary Data Report, Analytic Files and Public-Use Files.
These activities include production of a N-MHSS analytic data file with accompanying
documentation in SAS and ASCII format; production of a N-MHSS summary data report
including text and table preparation; production of print and electronic versions of the report for
publication on SAMHSA’s website; production of PDF and HTML versions of the data report
that are 508 compliant; production of an electronic version of the National Directory of Mental Health Treatment Facilities; and production of N-MHSS public-use data files and documentation.
Contract Monitoring. The cost for monitoring the contract and carrying out related work including the salary and travel for contractor site visits for three FTEs totals approximately $360,000.
Currently there are 20,604 burden hours in the OMB inventory. SAMHSA/CBHSQ is requesting 9,724 burden hours. The decrease of -10,880 burden hours are due to the following adjustments to the survey versions (two abbreviated and one full-scale).
An adjustment of response time of 45 minutes to 25 minutes (-7,990) is estimated for the 17,000 facility respondents in the Locator Survey in 2017 and 2019.
An adjustment of response time of 25 minutes to 45 minutes (2,890) and the incorrect recorded number of respondents of 1,700 to 17,000 (15,300) for the Locator Survey in 2018.
Time Schedule
The annual cycle of activities is as follows:
Activity |
Completion Date |
2017 N-MHSS1
|
|
Finalization the survey frame from the I-BHS, development of data collection materials and instrument (web, paper, and CATI)
|
February 2017
|
Creation of an informational and survey website
|
February 2017
|
Development of system for tracking/monitoring survey response status
|
March 2017
|
Advance letter mailing
|
March 2017 |
First cover letter mailing, including instructions for how to complete survey on the Internet
|
April 2017 |
First thank you/reminder letter mailing
|
May 2017 |
Second cover letter mailing, including paper questionnaire and prepaid return business reply envelope
|
June 2017 |
Second thank you/reminder letter mailing
|
July 2017 |
CATI interviewer training, and begin full interview calls to non-respondents
|
August 2017 |
Thank you notification to survey respondents
|
Ongoing throughout data collection
|
Development of machine cleaning specifications and creation of data file
|
January 2018 |
Update Mental Health Facility Locator database
|
March 2018 |
Publication of the National Directory of Mental Health Treatment Facilities |
March 2018 |
Development of analytic data file
|
April 2018 |
Analytic report
|
June 2018 |
Public use data files
|
June 2018 |
Process updates/changes to existing information in the I-BHS on a monthly basis
|
Ongoing throughout data collection
|
b. Analyses and Publications
The N-MHSS data will be disseminated in the following manner:
Behavioral Health Treatment Services Locator – This searchable web-based system on the Internet will link the facility listings to an online mapping function (see: https://findtreatment.samhsa.gov). Updates to add eligible new facilities and update changes to existing information will be made as needed. The mental health facility database is also made available to the office within HHS with responsibility for maintenance of the new federal website, www.MentalHealth.gov.
National Directory of Mental Health Treatment Facilities – This publication, available electronically through SAMHSA’s website (www.samhsa.gov), will include information on the same facilities that are listed in the online Locator. The facilities will be presented alphabetically by State, and within each State, alphabetized by city and then by facility name within the city. Information about each facility will include: facility name; street address; telephone number; intake telephone number; website address; type of facility; ownership; type of care setting offered; age groups of clients served; languages spoken; selected types of services offered; special programs offered; payment assistance offered; and accepted sources of payment for services.
N‑MHSS Annual Data Report – This publication will present the main findings from the N-MHSS including descriptive analyses of facility counts by facility characteristics, such as type of facility, service setting offered, and ownership. Descriptive analyses on client counts by demographic characteristics will also be included in reports generated from data collected in the full-scale N-MHSS.
Public-Use Data Files – Public-use (release) data files of N‑MHSS data will be available for downloading and for online analysis at the Substance Abuse and Mental Health Data Archive (SAMHDA) website, http://datafiles.samhsa.gov/.
Other Reports – Selected data from the N‑MHSS file (e.g., facility counts by type of facility) will be included in other statistical compilations, including, for example, the CDC/NCHS publication: Health, United States. In addition, analytic reports presenting
N-MHSS data will be included in the SAMHSA/CBHSQ Short Report, a statistical publication series available on the SAMHSA website.
The expiration date will be displayed.
This collection of information involves no exceptions to the Certification for Paperwork Reduction Act Submissions.
1 N-MHSS activities for subsequent years will be on a similar schedule
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | National Mental Health Services Survey (N-MHSS) Revision |
| Author | laura milazzo-sayre |
| File Modified | 0000-00-00 |
| File Created | 2021-01-23 |