In Victoria, Australia, systematic assessment of outcomes in mental health services are being instituted.

To carry out a large-scale field trial of the Health of the Nation Outcome Scales (HoNOS).

2137 clients were rated by mental health workers on the HoNOS, and about half were rated again within a few months.

While interrater reliability of the total score was satisfactory, that of some individual items was unacceptable. Significant associations with age and gender were found, and clients with non-psychotic disorders obtained higher (i.e. worse) ratings than those with psychotic disorders. There were relationships between service use and HoNOS total score. For the group as a whole, total scores had not changed at the second rating, but admissions and discharges were associated with increases and decreases in total score. Among clients in the community, there was no relationship between change in HoNOS total score and frequency of contacts.

Certain items, notably 11 and 12, were unreliable. The absence of evidence of sensitivity to change may be due to the short re-rating interval, little real change in the clients, or the characteristics of the scale itself.

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.

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.

The HoNOS has been developed as a routine measure of outcomes in mental health.

To explore the validity and interrater reliability of HoNOS in a first-onset psychosis follow-up study.

Between 1992 and 1994 we ascertained a cohort of all persons with first-onset psychosis. We re-assessed these people at 3 years (n=166) with several outcome scales, including HoNOS. Patients' keyworkers also completed the HoNOS. We estimated concurrent validity by calculating correlations between HoNOS and other scales, and interrater reliability.

Researcher HoNOS correlated highly with other scales (0.46 < p < 0.86; P < 0.001). Keyworker HoNOS correlations were lower (0.41 < p < 0.51; P < 0.05), but still significant for all scores except the HoNOS-social subscale (0.12 < p < 0.28). Agreements between researcher and keyworker HoNOS were modest (0.47 < ICC < 0.85).

In this research cohort HoNOS correlates well with established outcome scales. Keyworker ratings show similar, but weaker, relationships; its use in routine settings may require further training for calibration of severity.

Two recently developed measures intended for clinical use are HoNOS (Health of the Nation Outcome Scales), measuring social functioning, and CANSAS (Camberwell Assessment of Need Short Appraisal Schedule), for measuring need.

We investigated the association between CANSAS and HoNOS.

For some domains there were substantial associations, with high HoNOS rating correlated with CANSAS rating of the presence of a need. For other areas the agreement was less than might be expected. Seven factors were identified within the 22 CANSAS domains, and the presence of needs in the Drug/alcohol and Activities of daily living factors was associated with high scores in the related HoNOS domains.

CANSAS and HoNOS assessments differ. HoNOS can track changes in social functioning over time, but may be less useful for treatment planning, and should not be used to infer the level of morbidity in a case-load. CANSAS indicates when treatment should be commenced or continued. It can also be used as a case-load measure, but may be insufficiently sensitive to be used as an outcome measure at the individual level.

The Health of the Nation Outcome Scales (HoNOS) have been developed for assessing the effectiveness of mental health services.

To investigate the validity and reliability of the HoNOS in patients in contact with mental health services.

Subjects (age range 19–64) came from day hospitals, acute in-patient units and out-patient clinics in general practice. We obtained the opinions of experienced professionals, advocacy groups and patient groups to evaluate consensual and content validity.

One hundred patients were assessed using the package of rating scales. Interrater and test–retest reliability were good for some items and poor for others. The HoNOS had good criterion validity: acute in-patients had higher scores than day patients and out-patients. HoNOS also had good concurrent validity, correlating well with other scales. Comments suggested that the HoNOS was a useful and suitable scale for this population but psychotic symptoms and certain social factors were not sufficiently covered.

The HoNOS had good validity but variable reliability. It may be better than existing scales because of the wide range of areas which it covers.

Following the development of a child and adolescent version of the Health of the Nation Outcome Scales (HoNOSCA), field trials were conducted to assess their feasibility and acceptability in routine outcome measurement.

To evaluate the reliability, validity and acceptability of HoNOSCA in routine outcome measurement.

Following training, 36 field sites provided ratings on 1276 cases at one time point and outcome data on 906. Acceptability was assessed by way of written feedback and at a debriefing meeting.

HoNOSCA demonstrated satisfactory reliability and validity characteristics. It was sensitive to change and its ability to measure change accorded with the clinicians' independent rating. HoNOSCA was reasonably acceptable to clinicians' from a range of disciplines and services.

Provided that training needs can be met, HoNOSCA represents a satisfactory brief outcome measure which could be used routinely in child and adolescent mental health services.

There is an increasing interest in measuring health care outcomes in mental health services for children as well as adults.

We examined the sensitivity of the Paddington Complexity Scale (PCS) and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in describing the intakes of child and adolescent mental health clinics.

We carried out a prospective study of two out-patient units and one day patient unit, by means of questionnaires administered to clinicians, parents and children.

Clinician-rated PCS and HoNOSCAs were obtained for 248 new attenders. Both proved sensitive to intake differences between clinics. There were correlations of moderate intensity (r=0.6) between total PCS and HoNOSCA. There were weaker associations between these and parent/child rated measures of behaviour (r=0.4 and 0.3), quality of life and self-esteem (r=0.3 or less).

Both PCS and HoNOSCA are useful for describing clinical profiles of children and adolescents receiving mental health services.

Health of the Nation Outcome Scales (HoNOS) have been developed to measure outcomes in people with mental health problems.

The particular physical and cognitive problems affecting older people requires a specific scale for their measurement. We describe the development of such a scale, named HoNOS 65+.

Pilot, validity and reliability studies were carried out on an amended scale. Validity was assessed by comparison with existing scales reflecting depression, cognitive function, psychiatric symptomatology, activities of daily living and functional abilities. Reliability was measured in two centres.

HoNOS 65+ was successfully amended to include specific aspects of mental health problems in older people including the phenomenology of depression, delusions occurring in the presence of dementia, incontinence and agitation/restlessness. HoNOS 65+ was able to discriminate between people suffering from organic and functional illnesses. Correlations with other scales indicated reasonable validity. Reliability was satisfactory.

Aversion of HoNOS 65+ is presented (see pp. 435–438, this issue) which is appropriate for use in elderly people with mental health problems.

Family history data suggest the possibility of an association between childhood shyness and parental social phobia.

To examine the prevalence of maternal affective disorder in a community sample of four-year-old shy and non-shy children.

By screening 867 children, 43 shy children, 59 children with another form of disturbance (i.e. fearfulness, feeding problem or conduct problem) and 26 children with no disturbance were identified. Interviewers who were unaware of child status used a standardised mental state assessment to determine the rate of affective disorder in the mothers of these children.

Compared with the mothers of the children in both comparison groups, the mothers of the children who were purely shy (i.e. shy children with no comorbid condition) had a significantly raised lifetime rate of anxiety disorder in general, and social phobia in particular. The odds ratio of a social phobia in the mothers of the purely shy children was raised over the normal control group by a factor of more than seven.

These findings suggest a specific association between childhood shyness and maternal social phobia.

Recent studies indicate that selective serotonin re-uptake inhibitors (SSRIs) reduce the symptoms accompanying personality disorders and modulate a normal personality.

To examine the effect of two SSRIs, sertraline and Citalopram, on personality traits in major depressed patients.

Personality traits were evaluated at baseline and after six months using the Karolinska Scales of Personality (KSP).

After treatment, significant changes in the direction of normalisation were seen in all scales. To determine whether the observed changes could be explained by improved depressive symptoms, multiple stepwise regressions with the separate KSP as dependent variables were performed. Improvements in depressive symptoms only accounted for 0–8.4% of the observed variance.

In depressed patients treated with SSRIs significant effects are seen on personality traits measured by the KSP.

In healthy controls, preactivation of muscles by exercise results in enhanced motor-evoked potential (MEP) responses to transcranial magnetic stimulation (TMS).

We tested the hypothesis that medicated, depressed patients would show reduced post-exercise MEP facilitation compared with controls.

Ten patients with DSM-IV depression (two male, eight female) and ten controls (three male, seven female) participated. MEPs were elicited at rest, then after exercising the contralateral abductor pollicis brevis muscle, using TMS of the primary motor cortex.

The mean MEP amplitude recorded after exercise (expressed as a percentage of baseline) was 210% in controls and 130% in patients. There was a significant difference in post-exercise MEP between patients and controls (P=0.03).

Post-exercise MEP facilitation was demonstrated in controls but not in patients. This supports the hypothesis that the modulation of cortical excitability may be impaired in depression.

The past decade has witnessed a recognition that unsafe criminal convictions may be occasioned by unreliable confessions.

To present a case which illustrates the dangers of using abreaction interview techniques in a legal context and demonstrate the relevance of the memory distrust syndrome to an unsafe confession to murder.

We undertook a detailed assessment of a person appealing against his original murder conviction/the appellant’, and a careful scrutiny of all the relevant papers in the case.

The appellant served 25 years in prison before his conviction was quashed as ‘unsafe’ on the basis of fresh psychological and psychiatric evidence.

Amnesia for an offence had been misdiagnosed, and the use of repeated abreaction interviews had further confused both the appellant and the original court. At the Appeal Court, the advice was that the man had experienced a form of source amnesia which resulted in an unreliable confession.