A typology of satisfaction with mental health services based on Andersen’s behavioral model

  • Marilyn Fortin
  • Zhirong Cao
  • Marie-Josée Fleury
Original Paper



Patients with mental disorders (MDs) form a highly heterogeneous group, whose satisfaction with mental health services (MHS) may vary according to different variables. Identifying patient subgroups with similar levels of satisfaction may help identify variables that contribute to satisfaction or dissatisfaction with services. This study established a typology of patient satisfaction with MHS that revealed variables specific to each group.


The study included 325 patients with MDs across four health service networks offering integrated and diversified services. Data were collected using five standardized instruments, and participant medical records. A conceptual framework was developed, based on Andersen’s Behavioral Model, which integrates socio-demographic, clinical, needs-related and service use variables. Using cluster analysis, a typology of patient satisfaction was created.


Analyses yielded four patient clusters: two where levels of satisfaction were relatively high and two with lower levels of satisfaction (range 3.74–4.37). Greater care continuity and higher income related to greater patient satisfaction; whereas co-occurring MDs and substance use disorders (SUD), as well as more numerous and severe needs, characterized dissatisfied patients who were frequent users of MHS.


Results highlight the need for continuity of care and adequate socio-economic conditions for increasing patient satisfaction with MHS. Lower levels of satisfaction among patients with common MDs and SUDs suggest the importance of addressing their specific needs to enhance satisfaction and MH recovery.


Typology Cluster analysis Patient satisfaction Mental health services Andersen’s behavioral model 



This study was funded by the Fonds de la recherche en santé du Québec (FRSQ), Grant number 22367. We gratefully acknowledge the support of this agency; and would also like to thank the co-investigators and patients who participated in the research.

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Urben S, Gloor A, Baier V et al (2015) Patients’ satisfaction with community treatment: a pilot cross-sectional survey adopting multiple perspectives. J Psychiatr Ment Health Nurs 22:680–687CrossRefPubMedGoogle Scholar
  2. 2.
    Katsakou C, Bowers L, Amos T et al (2010) Coercion and treatment satisfaction among involuntary patients. Psychiatr Serv 61:286–292CrossRefPubMedGoogle Scholar
  3. 3.
    Bener A, Ghulum S (2013) Gender difference on patients’ satisfaction and expectation towards mental health care. Nigerian J Clin Prac 16(3):285–291CrossRefGoogle Scholar
  4. 4.
    Kuosmanen L, Hätönen H, Jyrkinen AR et al (2006) Patient satisfaction with psychiatric inpatient care. J Adv Nurs 55(6):655–663CrossRefPubMedGoogle Scholar
  5. 5.
    de Hann L, Kramer L, van Raay B et al. (2002) Priorities and satisfaction on the help needed and provided in a first episode of psychosis. A survey in five European Family Associations. Eur Psychiatry 17:425–433Google Scholar
  6. 6.
    Soergaard KW, Nivison M, Hansen V et al (2008) Treatment needs and acknowledgement of illness—importance for satisfaction with psychiatric inpatient treatment. BMC Health Serv Res 8:103CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Blenkiron P, Hammill CA (2003) What determines patients’ satisfaction with their mental health care and quality of life? Postgrad Med J 79:337–340CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Rosenheck R, Wilson NJ, Meterko M (1997) Influence of patient and hospital factors on consumer satisfaction with inpatient mental health treatment. Psychiatr Serv 48:1553–1561CrossRefPubMedGoogle Scholar
  9. 9.
    Yimer S, Yohannis Z, Getinet W et al (2016) Satisfaction and associated factors of outpatient psychiatric service consumers in Ethiopia Patient. Prefer Adher 10:1847–1852CrossRefGoogle Scholar
  10. 10.
    Mohamed EY, Sami W, Alotaibi A et al (2015) Patients’ satisfaction with primary health care centers’ services, Majmaah, Kingdom of Saudi of Saudi Arabia. Int J Health Sci 9(2):163–170Google Scholar
  11. 11.
    Gebhardta S, Wolakb AM, Hubera MT (2013) Patient satisfaction and clinical parameters in psychiatric inpatients—the prevailing role of symptom severity and pharmacologic disturbances. Compr Psychiatry 54:53–60CrossRefGoogle Scholar
  12. 12.
    Köhler S, Unger T, Hoffmann S et al (2015) Patient satisfaction with inpatient psychiatric treatment and its relation to treatment outcome in unipolar depression and schizophrenia. Int J Psychiatry Clin Pract 19:119–123CrossRefPubMedGoogle Scholar
  13. 13.
    Eytan A, Bovet L, Gex-Fabry M et al (2004) Patients’ satisfaction with hospitalization in a mixed psychiatric and somatic care unit. Eur Psychiatry 19:499–501CrossRefPubMedGoogle Scholar
  14. 14.
    Ruggeri M, Salvi G, Perwanger V et al (2006) Satisfaction with community and hospital-based emergency services amongst severely mentally ill service users—a comparison study in South-Verona and South-London. Soc Psychiatry Psychiatr Epidemiol 41:302–309CrossRefPubMedGoogle Scholar
  15. 15.
    Katsakou C, Bowers L, Amos Y et al (2010) Coercion and treatment satisfaction among involuntary patients. Psychiatric Serv 61:286–292CrossRefGoogle Scholar
  16. 16.
    Hueston WJ, Mainous AG III, Schilling R (1996) Patients with personality disorders: functional status, health care utilization, and satisfaction with care. J Fam Pract 42: 54PubMedGoogle Scholar
  17. 17.
    McCullum SL, Andrews JM, Gaughwin MD et al (2016) Patient satisfaction with treatment for alcohol use disorders: comparing patients with and without severe mental health symptoms. Patient Prefer Adher 10:1489CrossRefGoogle Scholar
  18. 18.
    Fleury MJ, Bamvita JM, Grenier G et al (2016) Adequacy of help received by individuals with severe mental disorders after a major healthcare reform in Quebec: predictors and changes at 5-years follow-up. Adm Policy Mental Health 43(5):799–812CrossRefGoogle Scholar
  19. 19.
    Broadbent E, Kydd R, Sanders D, Vanderpyl J (2008) Unmet needs and treatment seeking in high users of mental health services: role of illness perceptions. Aust NZ J Psychiatry 42(2):147–153CrossRefGoogle Scholar
  20. 20.
    Piat M, Sabetti J, Bloom D (2010) The transformation of mental health services to a recovery-oriented system of care: Canadian decision maker perspectives. Int J Soc Psychiatry 56(2):168–177CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Zahid MA, Ohaeri JU, Al-Zayed AA (2010) Factors associated with hospital service satisfaction in a sample of Arab subjects with schizophrenia. BMC Health Serv Res 10:294CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kitts RL, Gallagher K, Ibeziako P et al (2013) Parent and young adult satisfaction with psychiatry consultation services in a children’s hospital. Psychosomatics 54:575–584CrossRefPubMedGoogle Scholar
  23. 23.
    Lee J, Korczak D (2014) Factors associated with parental satisfaction with a pediatric crisis clinic (PCC). J Can Acad Child Adolesc Psychiatry 23:2Google Scholar
  24. 24.
    Ruggeri M, Lasalvia A, Salvi G et al (2007) Applications and usefulness of routine measurement of patients satisfaction with community-based mental health care. Acta Psychiatr Scand 116(437):53–65CrossRefGoogle Scholar
  25. 25.
    Kasprov WJ, Frisman L, Rosenheck RA (1999) Homeless veterans’ satisfaction with residential treatment. Psychiatric Serv 50(4):540–545CrossRefGoogle Scholar
  26. 26.
    Fleury MJ, Grenier G, Bamvita JM, Perreault M, Caron J (2011) Typology of adults diagnosed with mental disorders based on socio-demographics and clinical and service use characteristics. BMC Psychiatry 11:67CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 36(1):1–10CrossRefPubMedGoogle Scholar
  28. 28.
    Fleury MJ, Grenier G, Vallée C et al (2006) Implementation of the Quebec mental health reform (2005–2015). BMC Health Serv Res 10:1–15Google Scholar
  29. 29.
    Fleury MJ, Grenier G, Vallée C et al (2017) Implementation of integrated service networks under the Quebec Mental Health Reform: facilitators and barriers associated with different territorial profiles. Int Journal of Integrated Care 17(1):1–19CrossRefGoogle Scholar
  30. 30.
    Kessler RC, Calabrese JR, Farley PA et al (2013) Composite International Diagnostic Interview screening scales for DSM-IV anxiety and mood disorders. Psychol Med 243(8):1625–1637CrossRefGoogle Scholar
  31. 31.
    Tremblay J, Bamvita JM, Grenier G et al (2014) Utility of the Montreal assessment of need questionnaire for community mental health planning. J Nerv Ment Dis 202:677–687CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Slade M, Thornicroft G, Loftus L, Phelan M, Wykes T (1999) CAN Camberwell Assessment of Need. Gaskell, LondonGoogle Scholar
  33. 33.
    Durbin J, Goering P, Streiner DL et al (2004) Continuity of care: Validation of a new self-report measure for individuals using mental health services. J Behav Health Serv Res 31:279–296PubMedGoogle Scholar
  34. 34.
    Bohn MJ, Babor TF, Kranzler HR (1995) The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol 56:423–432CrossRefPubMedGoogle Scholar
  35. 35.
    Cocco KM, Carey KB (1998) Psychometric properties of the drug abuse screening test in psychiatric outpatients. Psychol Assess 10:408–414CrossRefGoogle Scholar
  36. 36.
    Jabbar F, Casey P, Schelten SL, Kelly BD (2011) What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service. Ir J Med Sci 180:195–201CrossRefPubMedGoogle Scholar
  37. 37.
    Ruud T, Aarre TF, Broeskov B et al (2016) Satisfaction with primary care and mental health care among individuals with severe mental illness in a rural area: a seven-year follow-up study of a clinical cohort. Int J Ment Health Syst 10:33CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Newman D, O’Reilly P, Lee SH, Kennedy C (2015) Mental health service users’ experiences of mental health care: an integrative literature review. J Psychiatr Ment Health Nurs 22(3):171–182CrossRefPubMedGoogle Scholar
  39. 39.
    Poremski D, Wise Harris D, Kahan D et al (2016) Improving continuity of care for frequent users of emergency departments: service user and provider. Gen Hosp Psychiatry 40:55–59CrossRefPubMedGoogle Scholar
  40. 40.
    Fleury M-J, Grenier G, Bamvita J-M et al (2014) Adequacy of help received among individuals with severe mental disorders. Adm Policy Ment Health 41:302–316CrossRefPubMedGoogle Scholar
  41. 41.
    Burke-Miller JK, Cook JA, Grey DD et al. (2006) Demographic characteristics and employment among people with severe mental illness in a multisite study. Community Ment Health J 42(2)Google Scholar
  42. 42.
    Canadian Mental Health Association (2014) Unemployement, mental health and substance use. Let’s discuss. Info sheets. Canadian Mental Health Association’s BC Division, pp 1–14.
  43. 43.
    Ruggeri M, Bisoffi G, Fontecedro L, Warner R (2001) Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach. The South Verona Outcome Project 4. Br J Psychiatry 178:268–275CrossRefPubMedGoogle Scholar
  44. 44.
    Bressington D, Mui J, Tse ML, Gray R, Cheung EF, Chien WT (2016) Cardiometabolic health, prescribed antipsychotics and health-related quality of life in people with schizophrenia-spectrum disorders: a cross-sectional study. BMC Psychiatry 16(1):411CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Filipcic I, Simunovic Filipcic I, Ivezic E, Matic K, Tunjic Vukadinovic N. Vuk Pisk S et al (2017) Chronic physical illnesses in patients with schizophrenia spectrum disorders are independently associated with higher rates of psychiatric rehospitalization; a cross-sectional study in Croatia. Eur Psychiatry 43:73–80CrossRefPubMedGoogle Scholar
  46. 46.
    Wright S, Gournay K, Glorney E, Thornicroft G (2000) Dual diagnosis in the suburbs: prevalence, need, and in-patient service use. Soc Psychiatry Psychiatr Epidemiol 35:297–304CrossRefPubMedGoogle Scholar
  47. 47.
    Lesage A, Vasiliadis H-M, Gagné M-A et al (2006) Prévalence de la maladie mentale et utilisation des services connexes au Canada: Une analyse des données de l’Enquête sur la santé dans les collectivités canadiennes. Initiative canadienne de collaboration en santé mentale, OttawaGoogle Scholar
  48. 48.
    Fleury MJ, Grenier G, Bamvita JM, Tremblay J (2013) Typology of persons with severe mental disorders. BMC Psychiatry 13:137CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Schulenberg JE, Maggs JL (2002) A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. J Studies Alcohol Suppl 14:54–70CrossRefGoogle Scholar
  50. 50.
    Goodwin R, Andersen RM (2002) Use of the behavioral model of health care use to identify correlates of use of treatment for panic attacks in the community. Soc Psychiatry Psychiatr Epidemiol 37(5):212–219CrossRefPubMedGoogle Scholar
  51. 51.
    Vasiliadis HM, Lesage A, Adair C, Boyer R (2005) Service use for mental health raisons: cross-provincial differences in rates, determinants, and equity of access. Can J Psychiatry 50(10):614–619CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Marilyn Fortin
    • 1
    • 2
  • Zhirong Cao
    • 2
  • Marie-Josée Fleury
    • 1
    • 2
  1. 1.Department of PsychiatryMcGill UniversityMontrealCanada
  2. 2.Douglas Hospital Research CentreMontrealCanada

Personalised recommendations