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Validation of the Health of the Nation Outcome Scales

  • Paul Bebbington (a1), Terry Brugha (a2), Trevor Hill (a2), Lucy Marsden (a1) and Suzanne Window (a2)...



The Health of the Nation Outcome Scales (HoNOS) were developed to assess the outcome of severe mental disorders in relation to the Health of the Nation Strategy for England.


To validate the HoNOS.


One hundred and fifteen patients were assessed by key workers using HoNOS, and by research workers using SCAN, SBS, and SRPS, and completing HoNOS in the light of this additional material. These assessments were repeated after 6 weeks.


The performance of HoNOS in the hands of key workers was generally poor, in relation both to the research workers' rating of HoNOS and to the criterion instruments. Performance was particularly poor when the change in scores was used as a measure of outcome.


There are serious problems in using HoNOS as a routine measure of clinical status in busy psychiatric services. Its performance is probably related to the training and experience of key workers. Sequential ratings are not a good method for assessing outcome. Managers and planners should be cautious in adopting HoNOS, but it is worthy of consideration in developing a suite of locally agreed outcome measures.


Corresponding author

Professor Paul Bebbington, Royal Free and University College Medical School, Department of Psychiatry and Behavioural Sciences, Archway Campus, Whittington Hospital, Highgate Hill, London N19 5NF


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Declaration of interest

This study was entirely funded by the Department of Health.



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Validation of the Health of the Nation Outcome Scales

  • Paul Bebbington (a1), Terry Brugha (a2), Trevor Hill (a2), Lucy Marsden (a1) and Suzanne Window (a2)...


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