Health of the Nation Outcome Scales (HoNOS)

One of the three mental health targets in the Health of the Nation is 'to improve significantly the health and social functioning of mentally ill people' (DOH, 1992). Therefore in 1993 the Department of Health (DOH) commissioned the Royal Colleague of Psychiatrists' research unit (CRU) to develop scales to measure the health and social functioning of people with severe mental illness. The initial aim was to provide a means of recording progress towards the Health of the Nation target 'to improve significantly the health and social functioning of mentally ill people'. The use of HoNOS is recommended by the English National Service Framework for Mental Health.

HoNOS was developed in order to construct an instrument brief enough to be found useful by busy clinicians (chiefly nurses and psychiatrists in everyday practice) but also robust enough to provide, when aggregate and anonymous and used within the framework of a minimum data set (MDS), an index of progress for local and national public health purposes. It is generally speaking simple to use and clinically acceptable, sensitive to change (or lack of change) and covers a broad range of clinical and social problems. The scales are now in use in general psychiatry and have been shown to have good reliability and validity.

The Health of the Nation Outcome Scales (HoNOS) includes 12 items designed to measure the problems patients have when admitted to a psychiatric hospital and to monitor to what extent these problems have diminished at discharge from hospital. The 12 items are split into four sections as follows: behaviours, impairments, symptoms and social functioning. Each item is scored 0-4 with a total score of 48. A higher score indicates more impaired functioning. The HoNOS takes on average 5 minutes to complete following a clinical interview. All clinical staff require training in order to be able to implement HoNOS as a method of measuring the social functioning of the patients.

The Royal Colleague of Psychiatrists has also developed a HoNOS 65+ as in the elderly the outcome may be complicated by cognitive decline concomitant physical illness. Dependency, psychopathology and quality of life may all be used as measures of outcome but there are no current brief comprehensive scales to measure outcomes in the elderly. A study undertaken by Shergill et al (1999) has shown that it is a useful and well constructed scale. HoNOS provides a short yet more comprehensive assessment of outcome. Shergill et al (1999) suggests that there may be considerable advantages in having in having a constant HoNOS and therefore a constant dataset across the adult age groups.

What is the relevance of this tool for the patient population at the John Munroe Hospital Group?

The JMH has a population of patients who are mainly suffering with server and enduring mental illness, this Tool allows clinical staff the opportunity to measure against it patients quality of life and again over a period of time to see if there are any significant changes which can then be reported to the care coordinator at CPA or other such clinical meetings. That is why the JMH will be introducing HoNOS in the next few weeks, Dr Ben Akande is fully trained in HoNOS and will be therefore training up all our clinical staff to a competent level.

Click here for more information on HoNOS

Matthew Harris

Managing Director