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Health of the Nation Outcome Scales
These are the original 12 scales that are sometimes used in the UK to rate mental health service users of working age. Together, they rate various aspects of mental and social health, each on a scale of 0-4. They are designed to be used by clinicians before and after interventions, so that changes attributable to the interventions (outcomes) can be measured. The scales are as follows:
Overactive, aggressive, disruptive or agitated behaviour
Non-accidental self-injury
Problem Drinking or Drug-taking
Cognitive Problems
Physical illness or disability problems
Problems associated with hallucinations and delusions
Problems with depressed mood
Other mental and behavioural problems
Problems with relationships
Problems with activities of daily living
Problems with living conditions
Problems with occupation and activities
Each scale is rated as follows:
| 0 | No problem |
| 1 | Minor problem requiring no action |
| 2 | Mild problem but definitely present |
| 3 | Moderately severe problem |
| 4 | Severe to very severe problem |
HoNOS65+
Health of the Nation Outcome Scales for Older Adults
These are 12 scales that are now used to rate older adult mental health service users. Together, they rate various aspects of mental and social health, each on a scale of 0-4. They are designed to be used by clinicians before and after interventions, so that changes attributable to the interventions (outcomes) can be measured.
The scales are as follows:
Behavioural disturbance
Non-accidental self injury
Problem Drinking or Drug Use
Cognitive Problems
Problems related to physical illness or disability
Problems associated with hallucinations and delusions
Problems associated with depressive symptoms
Other mental and behavioural problems
Problems with social or supportive relationships
Problems with activities of daily living
Overall problems with living conditions
Problems with work and leisure activities and the quality of the daytime environment
Each scale is rated as follows:
| 0 | No problem |
| 1 | Minor problem that is non-clinical: i.e. would not normally lead to intervention |
| 2 | Mild problem (that would justify intervention) |
| 3 | Moderate problem |
| 4 | Severe problem |
References
Allan S & McGonagle I (1997) A comparison of HoNOS with the Social Behaviour Schedule in three settings. Journal of Mental Health 6(2): 117-124
Amin S, Singh,SP, Croudace T, 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. The British Journal of Psychiatry May: 399-403
Anonymous (2000) HoNOS update. British Journal of Psychiatry. April 176: 392-395.
Ashaye O, Adebisi A, Newman E & Dhadphale M (1998) Resettlement and the Health of the Nation Outcome Scales (HoNOS) in the elderly. International Journal of Geriatric Psychiatry 13(8): 568-570
Ashaye O, Mathew G & Dhadphale M (1997) A comparison of older longstay psychiatric and learning disabilities inpatients using the Health of the Nation Outcome Scales. International Journal of Geriatric Psychiatry 12(5): 548-552
Ashaye O, Mathew G & Rigby E (1998) HoNOS in long-stay patients with learning disabilities. Psychiatric Bulletin 22(5): 306-308
Bebbington P, Brugha T, Hill T, Marsden L Window S (1999) Validation of the Health of the Nation Outcome Scales The British Journal of Psychiatry May174: 389-394
Boot B, Hall W & Andrews G. (1997) Disability, outcome and case-mix in acute psychiatric in-patient units. British Journal of Psychiatry. September 171: 242-246.
Brooker C, Molyneux P, Deverill M & Repper J (1997) An audit of costs and outcome using HoNOS-3 in a rehabilitation team: A pilot study. Journal of Mental Health 6(5): 491-502
Brooker C, Molyneux P, Deverill M & Repper J. (1999) Evaluating clinical outcome and staff morale in a rehabilitation team for people with serious mental health problems. Journal of Advanced Nursing. 29(1): 44-51.
Bruce J, Watson D, van Teijlingen ER, Lawton K, Watson MS & Palin AN. (1999) Dedicated psychiatric care within general practice: health outcome and service providers’ views. Journal of Advanced Nursing. 29(5): 1060-1067.
Burns A, Beevor A, Lelliott P, Wing J, Blakey A, Orrell M, Mulinga J & Hadden S (1999) Health of the Nation Outcome Scales for Elderly People (HoNOS 65+). Glossary for HoNOS65+ score sheet. The British Journal of Psychiatry May 174: 435-438 [But see Macdonald AJD below]
Burns, A, Beevor A, Lelliott P, Wing J, Blakey A, Orrell M, Mulinga J & Hadden S (1999) Health of the Nation Outcome Scales for Elderly People (HoNOS65+). The British Journal of Psychiatry May 174: 424-427
Carlisle D. (1996) Economies of scales. Nursing Times. 92 (50): 38-39.
Chaplin R & Perkins R (1999) HoNOS: A cautionary tale of their use in rehabilitation. Psychiatric Bulletin 23(1): 20-21
Cheah YC, Parker G, Hadzi-Pavlovic D, Gladstone G, & Eyers K. (1998) Development of a measure profiling problems and needs of psychiatric patients in the community. Social Psychiatry & Psychiatric Epidemiology. 33(7): 337-344.
Culiford L, Goff-Beardsley S & Atkinson T (1999) Usefulness of HoNOS. Psychiatric Bulletin 23(9): 571
Elphick M, Anthony P, Lines C & Evans H (1997) Mental Health: casemix outcome resource needs: Summary Report. The National Casemix Office: Winchester.
Elphick M, Anthony P, Lines C & Evans H (1997) Mental Health: casemix outcome resource needs. The National Casemix Office: Winchester.
Goldney RD, Fisher LJ & Walmsley SH (1998) The Health of the Nation Outcome Scales in psychiatric hospitalisation: A multi-centre study examining outcome and prediction of length of stay. Australian & New Zealand Journal of Psychiatry 32(2): 199-205
Gowers SG, Harrington RC, Whitton A, Lelliott P, Beevor A, Wing J & Jezzard R (1999) Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). The British Journal of Psychiatry May 174: 413-416
Gowers SG, Harrington RC, Whitton A, Beevor A, Lelliott P, Jezzard R & Wing JK (1999) Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): Glossary for HoNOSCA score sheet. The British Journal of Psychiatry May 174: 428-431.
Grant B & Deaney C (1998) Inner-city general practice population of people with schizophrenia. Psychiatric Bulletin 22(4): 221-225.
Issakidis C & Teesson M (1999) Measurement of need for care: A trial of the Camberwell Assessment of need and the Health of the Nation Outcome Scales. Australian & New Zealand Journal of Psychiatry 33(5): 754-759
James, M & Kehoe R (1999) Using the Health of the Nation Outcome Scales in clinical practice. Psychiatric Bulletin 23(9): 536-538
Jeffries M (1996) A culture of effective efficiency. NHS Magazine. Autumn (6): 12-13.
Macdonald AJD. (1999) HoNOS 65+ glossary.British Journal of Psychiatry. August 175: 192.
McClelland R, Trimble P, Fox ML, Stevenson MR & Bell B. (2000) Validation of an outcome scale for use in adult psychiatric practice. Quality in Health Care. June 9(2): 98-105.
Mozley CG, Huxley P, Sutcliffe C, Bagley H, Burns A, Challis D & Cordingley L. (1999) ‘Not knowing where I am doesn’t mean I don’t know what I like’: cognitive impairment and quality of life responses in elderly people. International Journal of Geriatric Psychiatry. 14(9): 776-783.
Orrell M, Yard P, Handysides J & Schapira R (1999) Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community. The British Journal of Psychiatry May 174: 409-412
Pirkis J, Burgess P & Jolley D.(1999) Suicide attempts by psychiatric patients in acute inpatient, long-stay inpatient and community care. Social Psychiatry & Psychiatric Epidemiology. 34(12): 634-644.
Sharma VK, Wilkinson G & Fear S. (1999) Health of the Nation Outcome Scales: a case study in general psychiatry. British Journal of Psychiatry. May 174: 395-398.
Slade M, Beck A, Bindman J, Thornicroft G & Wright S (1999) Routine clinical outcome measures for patients with severe mental illness: CANAS and HoNOS. The British Journal of Psychiatry May 174: 404-408
Taylor JR & Wilkinson G (1997) HoNOS vs opinion in a shifted out-patient clinic. Psychiatric Bulletin 21(8): 483-485
Trauer T (1999) The subscale structure of the Health of the Nation Outcome Scales (HoNOS). Journal of Mental Health 8(5): 499-509
Trauer T, Callaly P, Hantz P, Little J, Shields R & Smith J (1999) Health of the Nation Outcome Scales. Results of the Victorian field trial. The British Journal of Psychiatry May174:8
Trauer T, Callaly T & Hantz P. (1999) The measurement of improvement during hospitalisation for acute psychiatric illness. Australian & New Zealand Journal of Psychiatry. 33(3): 379-384.
Wing JK, Curtis RH & Beevor A (1999) Health of the Nation Outcome Scales ( HoNOS): Glossary for HoNOS score sheet. The British Journal of Psychiatry May 174: 432-434.
Wing J, Curtis RH & Beevor A (1999) Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Glossary for HoNOS score sheet. The British Journal of Psychiatry May 174: 432-434
Wing JK, Beevor A, Curtis RH, Park SBG, Hadden S & Burns A (1998) Health of the Nation Outcome Scales (HoNOS): Research and development. British Journal of Psychiatry Jan 172:11-18
Wing, J, Lelliott P & Chaplin RH (1999) Reliability and validity of HoNOS (multiple letters). Psychiatric Bulletin 23(6):375
Wing, JK, Curtis RH & Beevor AS (1996) HoNOS: Health of the Nation Outcome Scales: Report on Research and Development July 1993-December 1995. Royal College of Psychiatrists: London
Yates P, Garralda & Higginson I (1999) Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents. The British Journal of Psychiatry May 174: 413-416
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