Translating ethical principles into outcome measures for mental health service research

Background. Mental health service research continues to use only outcome me asures that are available rather than develop measures that are important. This paper argues that it is necessary to select and then define a set of e thical principles that can be operationalized and validated as outcome meas ures to provide a wider balance of information for health policy and clinic al service decisions. Methods. The method used is to adopt a five stage procedure: (i) to select ethical principles most directly relevant for mental health services and th eir evaluation at the local level; (ii) to propose definitions of these pri nciples; (iii) to validate these definitions; (iv) to translate the defined principles into operationalized outcome measures; and (v) to use these out come measures in mental health services research, within the context of evi dence-based medicine. Results. We address steps (i) and (ii) of this five-stage procedure. Nine p rinciples are selected and defined: autonomy, continuity, effectiveness, ac cessibility, comprehensiveness, equity, accountability, coordination and ef ficiency. These principles can together be referred to as the three ACEs. Conclusions. Of these nine principles, only two (effectiveness and efficien cy) have so far been fully translated into quantitative outcome measures, u pon which the evidence-based medicine approach depends. We propose that fur ther concepts also be developed into a more complete multidimensional range of fully operationalized outcome measures.