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Health of the Nation Outcome Scales: A case study in general psychiatry

  • Vimal K. Sharma (a1), Greg Wilkinson (a2) and Simon Fear (a2)



Health of the Nation Outcome Scales (HoNOS) were incorporated in a data set recording the routine clinical activities of a mental health team in Liverpool.


To evaluate the use of HoNOS in general adult psychiatry.


All consecutive patients who came in contact with the mental health team were administered HoNOS by the consultant psychiatrist. A cohort (n=204) of patients was identified over a period of 8 months. All patients (n=156) who had a repeat HoNOS after an interval of 6 months were included in the study.


There was an overall reduction in HoNOS scores after an interval of 6 months, more so among patients with psychotic and affective disorders. Patients scoring on other disorders showed no change on HoNOS. The measured change in clinical state based on the Clinical Global Impression scale was broadly consistent with HoNOS scores.


It was feasible to administer HoNOS during routine assessments, but HoNOS data were of limited value in care-planning in day-today clinical practice. The widespread adoption of HoNOS for use in routine clinical practice would be premature.


Corresponding author

Dr Simon Fear, Lecturer in Medical Statistics, University of Liverpool, Liverpool L69 3GA


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Declaration of interest

This was a joint project between the Mental Health Directorate, University Hospital Aintree and Liverpool Health Authority.



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Department of Health (1992) Health of the Nation. London: HMSO.
Guy, W. (1976) ECDEU Assessment Manual for Psychopharmocology (revised DHEW pub. ADM). Rockville. MD: National Institute of Mental Health.
Taylor, J. R. & Wilkinson, G. (1997) HoNOS v. GP opinion in a shifted out-patient dink. Psychiatric bulletin, 21, 483485.
Willdnson, G., Williams, B., Krehorian, H., et al (1992) QUALY in mental health: a case study. Psychological Medicine, 22, 725731.
Wing, J. K., Beevor, A. S., Curtis, R. H., et al (1998) Health of the Nation Outcome Scales (HoNOS). Research and development. British Journal of Psychiatry, 172, 1118.
World Health Organization (1992) The ICD-10 Classification of Mental and behavioural Disorders. Geneva: WHO.

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Health of the Nation Outcome Scales: A case study in general psychiatry

  • Vimal K. Sharma (a1), Greg Wilkinson (a2) and Simon Fear (a2)


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