Section 2: Methods and Engagement
Research questions
Research topics for the 2025 analysis closely mirrored the research topics for the 2019 analysis to measure changes over time.
The following questions guided the 2025 project:
- What are the major systems-level gaps in the availability of mental health and substance use services?
- What are the barriers to accessing mental health and substance use services?
- Are there areas/regions wherein the gaps are particularly pronounced?
- Are there populations that are particularly underserved by the mental health and substance use services system?
- What gaps in the mental health and substance use services workforce impact its ability to meet the needs of the population?
- What are the recommendations from providers and people being served for improving the mental health and substance use services system?
Data sources
A mixed-method approach was used to gather input from all collaborators in Wisconsin's mental health and substance use services system.
The UW Population Health Institute conducted interviews and focus groups with providers of services and people receiving services. The UW Population Health Institute also created a public-facing survey.
Interviews (n=21)
Interview participants ranged in roles from state agency staff, county health and human services directors and managers, as well as advocacy agency leaders. Specific perspectives were solicited to capture gaps related to urban and rural geographies, adult and youth services, as well as statewide and local barriers. Fifteen key informant interviews were conducted between April and May of 2025, with a total of 21 people.
Interviews: role of participants in the mental health and substance use services system
| Role | Count | Percent |
|---|---|---|
| Director, administrator, supervisor, other state agency staff | 11 | 58% |
| Advocate | 3 | 16% |
| Care provider or coordinator | 3 | 16% |
| Family member of a person receiving services | 3 | 16% |
| Other | 2 | 11% |
| Clinical supervisor | 1 | 5% |
Interviews: area of expertise of participant in the mental health and substance use services system
| Area of expertise | Count | Percent |
|---|---|---|
| Policymaking or policy implementing | 15 | 79% |
| Advocacy | 11 | 58% |
| Access/outreach | 7 | 37% |
| Outpatient services | 5 | 26% |
| Crisis services | 4 | 21% |
| Criminal justice | 2 | 11% |
| Homeless services | 2 | 11% |
| Residential services | 2 | 11% |
| Inpatient services | 2 | 11% |
Focus groups (n=15)
Focus group participants included county health and human services administrators. Five focus groups held in June 2025 captured perspectives from eight people, reflecting counties of various population volumes across the state. Seven people with lived or living experience with a substance use disorder participated in a focus group at the Wisconsin Harm Reduction Conference in July 2025.
Survey (n=1,771)
A public-facing survey was based on the survey used for the 2019 analysis with some revisions. Respondents were able to answer questions about mental health services, substance use services, or both. The Wisconsin Department of Health Services promoted this survey in August 2025 through several email blasts to people with lived or living experience with mental health and substance use services; their families, friends, and advocates; and providers of services. This survey also was promoted through Wisconsin Department of Health Services social media. The 1,771 responses were analyzed using descriptive statistics.
Survey respondents: current experience with mental health and substance use services system
| Current experience | Count | Percent |
|---|---|---|
| Person receiving or family member of a person receiving mental health and/or substance use services | 691 | 39% |
| Community-based mental health and substance use services provider, manager, or administrator | 602 | 34% |
| Advocate | 443 | 25% |
| County government staff, manager, or administrator | 283 | 16% |
| Recovery coach, peer support specialist, parent peer specialist | 142 | 8% |
| Inpatient or residential mental health and substance use services provider, manager, or administrator | 142 | 8% |
| Long-term care provider | 124 | 7% |
| Crisis intervention staff, manager, or administrator | 124 | 7% |
| Criminal justice system staff | 71 | 4% |
| Wisconsin Department of Health Services staff | 71 | 4% |
| Primary care manager or administrator | 53 | 2% |
| Tribal nation member | 35 | 2% |
| City government staff, manager, or administrator | 35 | 2% |
| Other state agency staff | 35 | 2% |
Twenty-two percent of respondents submitted other experiences with the Wisconsin mental health and substance use services system, including: medical professionals, social workers, case managers, local or Tribal nation government staff, social service providers, guardians, educators, clergy or faith leaders, legal professionals, and insurance or benefit coordinators. Over half of all respondents indicated experience working with or on behalf of Wisconsinites insured with Medicaid, or Medicare.
In summary, respondents to the survey predominantly identified as: white, female, between age 25 and 65, heterosexual, and having over 10 years of experience in/with the Wisconsin's mental health and substance use services system as a person in services, a family member of a person in services, or within a policy making or implementation role.
Limitations
Though this analysis used a mixed methods approach to reduce bias, limitations remain.
Critically, sampling bias was present in the survey and selection of key informants for the interviews and focus groups. Though the survey was opened 3,400 times, only 1,771 responses were received. The survey length may have impacted respondents’ capacity and quality to answer questions. Survey answer options and question order were randomized to mitigate bias where possible.
Additionally, survey respondents were recruited from sources with data about people with existing connections to the Wisconsin Department of Health Services. A similar method was used with interviews. The people interviewed were selected to provide perspectives based on their specific roles, offering a holistic view of system strengths and challenges though also potentially influenced because of their unique knowledge.
The majority of those engaged with this analysis identified as white, female, and from southern Wisconsin. This may not fully encompass the diversity or experiences of all those interacting with the Wisconsin mental health and substance use services system. In addition to social identities, the survey may have excluded those with limited internet access, those who cannot read or write English, and other constraints.
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Next - Section 3: Findings - Gaps in the System