Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service

  • James SweeneyEmail author
  • Dimitrios Adamis
  • Luqman Helmi
  • Alastair J. D. Macdonald
Original Article



Routine clinical outcome monitoring (RCOM) is the standardised gathering of measures of clinical outcomes in everyday practice. HoNOS (Health of the Nation Outcome Scales) is a tool used in RCOM.


To examine (a) agreement between HoNOS and Global Assessment of Functioning (GAF), (b) HoNOS changes over time/attendance and (c) clinical parameters affecting HoNOS scores.


Data from outpatient clinics were collected at each contact over 2 years until June 2016 including: gender, age, diagnosis (ICD-10) and HoNOS scores. In a subsample, the GAF also were completed by community psychiatric nurses blind to HoNOS scores.


A number of 470 outpatients have undergone 1125 HoNOS assessments during the study period. Mean age of the attendants was 43.12; SD 14.6. Male = 220 (46.8%). Longitudinal analysis demonstrated that lower HoNOS scores are independently significantly associated to number of assessments and diagnosis in ICD-10 categories of F20–F29 (Schizophrenia, schizotypal and delusional disorders) F30–F39 (mood disorders) F40–F48 (neurotic, stress-related and somatoform disorders) and F50–F59 (behavioural disorders associated with physiological disturbances). Gender and age were not significantly associated with decline of HoNOS scores. Neither were other diagnostic categories. Agreement between HoNOS and GAF was excellent (N = 261, rho = − 0.919, p < 0.001).


This study shows that HoNOS is a feasible instrument which can be potentially used in ROCM in mental health services in Ireland and supports further the need for implementation of routine measurements in Mental Health Services. It adds longitudinal data which is lacking in similar previous studies.


HoNOS Ireland Outcomes Outpatient Psychiatry 



We would like to thank the Doctors and CPNs working in this Mental Health Team for completion of the scales.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

The project was approved by the Ethics Committee of Sligo University Hospital.


  1. 1.
    Carlier IVE, Meuldijk D, van Vliet IM, van Fenema E, van der Wee NJA, Zitman FG (2012) Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. J Eval Clin Pract 18(1):104–110CrossRefGoogle Scholar
  2. 2.
    Quality and Effectiveness Section Mental Health & Suicide Prevention Branch Department of Health and Ageing (2003) Mental health national outcomes and case mix collection: overview of clinician related and consumer self-report measuresGoogle Scholar
  3. 3.
    New Zealand Ministry of Health (2012), Rising to the challenge: the Mental Health and Addiction Service Development Plan 2012–2017Google Scholar
  4. 4.
    Mental Health Commission Ireland (2006) Mental Health Commission Ireland Quality Framework for Mental Health ServicesGoogle Scholar
  5. 5.
    Wing JK, Beevor AS, Curtis RH, Park SGB, Hadden J, Burns A (1998) Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 172:11–18CrossRefGoogle Scholar
  6. 6.
    McCrossan P, Ryan A, Connellan M, Power P (2017) The impact of a specialized inpatient and day patient group programme on clinical outcome in older adolescents and young adults with mental illness. Ir J Psychol Med 34(1):39–44CrossRefGoogle Scholar
  7. 7.
    O’Brien S, McFarland J, Kealy B, Pullela A, Saunders J, Cullen W, Meagher D (2012) A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness. Ir J Med Sci 181(3):301–308CrossRefGoogle Scholar
  8. 8.
    Pirkis JE, Burgess PM, Kirk PK et al (2005) A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health Qual Life Outcomes 3(2005):76CrossRefGoogle Scholar
  9. 9.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric AssociationGoogle Scholar
  10. 10.
    Hall RC (1995) Global assessment of functioning. A modified scale. Psychosomatics 36(3):267–275CrossRefGoogle Scholar
  11. 11.
    Microsoft Corporation. SQL Server (2008) R2. Redmond. Microsoft Corporation, Washington, p 2010Google Scholar
  12. 12.
    IBM Corp (2014) IBM SPSS statistics for Windows. In: Version 23, vol 0. NY, ArmonkGoogle Scholar
  13. 13.
    Browne S, Doran M, McGauran S (2000) Health of the Nation Outcome Scales (HoNOS): use in an Irish psychiatric outpatient population. Ir J Psychol Med 17(1):17–19CrossRefGoogle Scholar
  14. 14.
    Meagher D, O’Brien S, Pullela et al (2009) Multidisciplinary activities in a community mental health service: relationship to Health of the Nation Outcome Scale scores and diagnosis. Psychiatrist 33(5):172–175Google Scholar
  15. 15.
    Trauer T, Coombs T, Eagar K (2002) Training in routine mental health outcome assessment: the Victorian experience. Aust Health Rev 25(2):122–128CrossRefGoogle Scholar
  16. 16.
    Amin S, Singh SP, Croudace T, Jones P, Medley I, Harrison G (1999) Evaluating the Health of the Nation Outcome Scales. Reliability and validity in a three-year follow-up of first-onset psychosis. Br J Psychiatry 174(5):399–403CrossRefGoogle Scholar
  17. 17.
    Parker G, O'Donnell M, Hadzi-Pavlovic D, Proberts M (2002) Assessing outcome in community mental health patients: a comparative analysis of measures. Int J Soc Psychiatry 48(1):11–19CrossRefGoogle Scholar
  18. 18.
    Phuaphanprasert B, Srisurapanont M, SilpakitMD C et al (2007) Reliability and validity of the Thai version of the Health of the Nation Outcome Scales (HoNOS). J Med Assoc Thail 90(11):2487–2493Google Scholar
  19. 19.
    Killaspy H, Banerjee S, King M et al (2000) Prospective controlled study of psychiatric out-patient non-attendance: characteristics and outcome. Br J Psychiatry (2000) 176:160–165CrossRefGoogle Scholar
  20. 20.
    Eagar K, Trauer T, Mellsop G (2005) Performance of routine outcome measures in adult mental health care. Aust N Z J Psychiatry 39(8):713–718CrossRefGoogle Scholar
  21. 21.
    Trauer T (2003) Analysis of outcome measurement data from the four Victorian round one agencies. In: Mental health branch. Department of Human Services, VictoriaGoogle Scholar
  22. 22.
    Trauer T, Callaly T, Little J et al (1999) Health of the Nation Outcome Scales (HoNOS): results of the Victorian field trial. Br J Psychiatry 174:380–388CrossRefGoogle Scholar
  23. 23.
    Macdonald AJ, Adamis D, Craig, et al. (2018) Continuity of care and clinical outcomes in thecommunity for people with severe mental illness. The British Journal of Psychiatry(2018): 1-6. Published online: 05 December 2018 Google Scholar
  24. 24.
    Trauer T, Gill L, Pedwell G, Slattery P (2006) Routine outcome measurement in public mental health—what do clinicians think? Aust Health Rev 30(2):144–147CrossRefGoogle Scholar
  25. 25.
    Coombs T, Stapley K, Pirkis J (2011) The multiple uses of routine mental health outcome measures in Australia and New Zealand: experiences from the field. Australas Psychiatry 19(3):247–253CrossRefGoogle Scholar
  26. 26.
    Happell B (2008) Meaningful information or a bureaucratic exercise? Exploring the value of routine outcome measurement in mental health. Issues Ment Health Nurs 29(10):1098–1114CrossRefGoogle Scholar
  27. 27.
    Meehan T, McCombes S, Hatzipetrou L et al (2006) Introduction of routine outcome measures: staff reactions and issues for consideration. J Psychiatr Ment Health Nurs 13(5):581–587CrossRefGoogle Scholar
  28. 28.
    Walter G, Cleary M, Rey JM (1998) Attitudes of mental health personnel towards rating outcome. J Qual Clin Pract 18(2):109–115Google Scholar
  29. 29.
    Macdonald AJ, Trauer T (2010) Objections to routine clinical outcomes measurement in mental health services: any evidence so far? J Ment Health 19(6):517–522CrossRefGoogle Scholar
  30. 30.
    Callaly T, Hyland M, Coombs T, Trauer T (2006) Routine outcome measurement in public mental health: results of a clinician survey. Aust Health Rev 30(2):164–173CrossRefGoogle Scholar
  31. 31.
    Trauer T, Pedwell G, Gill L (2009) The effect of guidance in the use of routine outcome measures in clinical meetings. Aust Health Rev 33(1):144–151CrossRefGoogle Scholar
  32. 32.
    Willis A, Deane FP, Coombs T (2009) Improving clinicians' attitudes toward providing feedback on routine outcome assessments. Int J Ment Health Nurs 18(3):211–215CrossRefGoogle Scholar
  33. 33.
    Boswell JF, Kraus DR, Miller SD, Lambert MJ (2015) Implementing routine outcome monitoring in clinical practice: benefits, challenges, and solutions. Psychother Res 25(1):6–19CrossRefGoogle Scholar
  34. 34.
    Macdonald AJ, Fugard AJ (2015) Routine mental health outcome measurement in the UK. Internat Rev Psychiatry 27(4):306–319CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Sligo Leitrim Mental Health ServiceSligoIreland
  2. 2.Clinical Outcomes ResearchInstitute of Psychiatry, Psychology and NeuroscienceLondonUK

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