A path through outcomes to recovery
One of the biggest challenges in mental health care is showing that the service helps people recover, through evidence of good outcomes. In the 1990’s the Health of the Nation Outcome Scales were launched by the Department of Health. Today “HoNOS” is the most widely-used routine mental health outcome measure in the world. The family of HoNOS measures are relatively brief, but also rather insensitive to change.
The Government and Commissioners rightly require outcome data such as HoNOS, and these have been incorporated into national and local reporting standards. However the rate of returns from NHS Trusts and Independent providers has been low. One reason for this is confusion over truly meaningful reporting standards. It has never been more important than now that we see innovation in outcomes research.
St Andrew’s has a programme of outcomes work bespoke for each user group. Our academic team (at St Andrew’s National Brain Injury Centre and Services for Older People) is a world leader in neuro-behavioural outcomes. St Andrew’s secure Services for Women is leading an outcome study in association with Leicester University.
We have also developed HoNOS-secure, supported by the Royal College of Psychiatrists Research Unit. This tracks the need for secure care and risk management, with the family of HoNOS tools tracking wider progress, for adult mental health, learning disability, adolescents, older age or brain injury. HoNOS-secure will be part of NHS electronic returns, and is being used across the UK. St Andrew’s produces charity-wide integrated outcome data using HoNOS-secure as part of a Balanced Scorecard. An improvement score is generated for users, units and services, and shared with teams, together with data on incidents, quality of care and levels of therapeutic activity. Based on attentive ratings by well-motivated practitioners, data across the charity shows improving effectiveness.
We now plan to roll out integrated outcome reporting with a new suite of tools, building on our research streams, and a version of the Recovery Star (see www.mhpf.org.uk ). We expect to have both HoNOS and a bespoke tool more sensitive to the needs of each user group, producing information for users, for the charity and for our commissioners.
Commissioners are now asking - what proportion of users are improved at 6 months? This is really new neat reporting standard, and a question we must be able to answer.
Dr Philip Sugarman, Medical Director and Chief Executive
References:
Alderman N, Knight C & Morgan C. (1997) Use of a modified version of the Overt Aggression Scale in the measurement and assessment of aggressive behaviours following brain injury. Brain Injury 11, 503-523
Knight C, Alderman N, Johnson C, Green S, Birkett-Swan L & Yorston, G. (2008). The St Andrew’s Sexual Behaviour assessment (SASBA): development of a standardised recording instrument for the measurement and assessment of challenging sexual behaviour in people with progressive and acquired neurological impairment. Neuropsychological Rehabilitation, 18, 129–159. http://www.stah.org/sasba/index.html
Dickens G, Walker L & Sugarman P (2007). Inter-rater reliability of HoNOS-Secure. Journal of Forensic Psychiatry and Psychology 18, 507-514.
Long C, Fulton B & Hollin C (2008).The development of a ‘Best Practice’ service for women in a medium-secure setting: treatment components and evaluation. Clinical Psychology and Psychotherapy15, 304 -19
Sugarman P (2007). Governance and innovation in mental health. Psychiatric Bulletin 31, 283-285.