A meaningful outcome measure for secure mental health services
Producing meaningful outcome data has historically proven challenging to the mental health sector. Over the past 10 years, with the increase in the scale and breadth of secure services, the need for one universal, easy to use assessment scale has become clear. In response to this, Dr Philip Sugarman and Lorraine Walker, both of St Andrew’s Healthcare, have worked in partnership with the Royal College of Psychiatrists to develop HoNOS-secure (Health of the Nation Outcome Scale – secure version).
This latest version, evolved from HoNOS-MDO (Mentally Disordered Offenders), comprises the original 12 HoNOS items modified for secure environments, coupled with an additional 7 items. Designed to complement and be used alongside the existing family of HoNOS scales, which includes HoNOS-CA for adolescents and HoNOS-LD for patients with learning disabilities, HoNOS-secure tracks and evaluates a service user’s need for secure care and risk management. Once completed, it provides a profile of 19 severity ratings, a total HoNOS score and a separate security score.
Generating improvement rates
Here at St Andrew’s, this information is used as an outcome measure within a ‘Balanced Scorecard’ (Sugarman, P.) approach. A 90 day improvement rate is generated for each patient, based on two sets of scores taken at different times. This gives data on ‘rate of change’ and improvement by each HoNOS subscale and total; by patient, by unit and by service. Each clinical team is empowered with information on an individual’s progress and challenged to understand what changes can be made to improve the effectiveness of its service user interventions.
Initial data publication proves promising
St Andrew’s outcome data is to be published later this year in Psychiatric Bulletin. Reporting on the UK’s largest and most diverse service user population, the information will show strengthening evidence of effectiveness over time, suggesting that outcome measures can bring an improved focus for patient benefit.
HoNOS-secure has been given free of charge to NHS Connecting for Health and the scale has been widely adopted by many UK Mental Health Trusts. A number of presentations and training seminars are scheduled throughout the year.
| |
The Seven Security Scales |
| A |
risk of harm to adults or children |
| B |
risk of self-harm (deliberate or accidental) |
| C |
need of building security to prevent physical escape |
| D |
need for a safely staffed living environment |
| E |
need for escort on leave (beyond the secure perimeter) |
| F |
risk to inidividual from others |
| G |
need for risk management procedures |
“We have truly embraced HoNOS-secure across the charity”, said Dr Philip Sugarman, CEO of St Andrew’s. “This has enabled us to produce valuable data which we are proud to be publishing and sharing. We have also produced some simple key performance indicators (KPIs) to make our outcome and improvements data easier to understand and more relevant to commissioners.”