The Scottish 700 outcomes study: A comparative evaluation of the Health of the Nation Outcome Scale (HoNOS), the Avon Mental Health Measure (AVON), and an Idiographic Scale (OPUS) in adult mental health

Background: Although many outcome measures are available, there is little empirical evidence to help clinicians to decide which to adopt in clinical, as opposed to research settings. Aims: To assess the content validity and levels of agreement between professionals and service users of three approaches to outcome measurement - a standard measure devised by mental health professionals (Health of the Nation Outcome Scale, HoNOS), a standard measure devised by service users and health professionals in partnership (the Avon Mental Health Measure, AVON), and an idiographic scale the Outcome of Problems of Users of Services (OPUS). Method: The three measures were completed by nearly 700 predominantly long-term users of mental health services, and by their key worker clinicians. All major psychiatric diagnoses were represented in the cohort. A small sub-sample had repeat testing after 3 months to assess sensitivity to change of the three measures. Results: Agreement between the three measures was low. Avon was more likely to detect problems, and to produce agreement between service users and key-workers, than HoNOS. Both omit key problem areas elicited using OPUS. All measures were sensitive to change. Conclusion: The Avon detects problems that service users judge to be important. Declaration of interest: The current study was funded wholly by the Chief Scientist Office of the Scottish Executive; RH has in the past been in receipt of educational support from a number of pharmaceutical companies.