Validation of the Health of the Nation Outcome Scales

Background The Health of the Nation Outcome Scales (HoNOS) were developed t o assess the outcome of severe mental disorders in relation to the Health o f the Nation Strategy for England. Aims To validate the HoNOS. Method One hundred and fifteen patients were assessed by keyworkers using H oNOS, and by research workers using SCAN, SBS, and SRPS, and completing HoN OS in the light of this additional material. These assessments were repeate d after 6 weeks. Results The performance of HoNOS in the hands of keyworkers was generally p oor, in relation both to the research workers' rating of HoNOS and to the c riterion instruments. Performance was particularly poor when the change in scores was used as a measure of outcome. Conclusions There are serious problems in using HoNOS as a routine measure of clinical status in busy psychiatric services. Its performance is probabl y related to the training and experience of keyworkers. Sequential ratings are not a good method for assessing outcome. Managers and planners should b e cautious in adopting Ho NOS, but it is worthy of consideration in develop ing a suite of locally agreed outcome measures. Declaration of interest This study was entirely funded by the Department of Health.