Health of the Nation Outcome Scales (HoNOS)

HoNOS (2018)

Since the publication of the Health of the Nation Outcome Scales (HoNOS) in 1996, they have demonstrated adequate reliability, validity, clinical utility and sensitivity to change.   England, Australia, and New Zealand, have also mandated the HoNOS for routine monitoring and outcome measurement across their mental health services at a national level.

Whilst recognising this basic soundness, two decades of training, use and analysis, together with advances in psychiatry and mental health services, resulted in a recognition that updates to the glossary are required to improve use of the HoNOS. The Royal College of Psychiatrists (RCPsych) elected to undertake a limited review (rather than a full redevelopment and revalidation) that aimed to use expert opinion to improve the utility of the HoNOS: remaining true to its original aims and maintaining comparability with existing datasets, whilst improving rater experience by removing ambiguity and inconsistency in the glossary.

FAQs

Frequently asked questions about HoNOS

In 1993 the UK Department of Health commissioned the Royal College of Psychiatrists’ Research Unit (CRU) to develop scales to measure the health and social functioning of people with severe mental illness. The initial aim was to provide a means of recording progress towards the Health of the Nation target ‘to improve significantly the health and social functioning of mentally ill people’

Development and testing over three years resulted in an instrument with 12 items measuring behaviour, impairment, symptoms and social functioning (Wing, Curtis & Beevor, 1996).  The scales are completed after routine clinical assessments in any setting and have a variety of uses for clinicians, researchers and administrators, in particular health care commissioners and providers. The scales were developed using stringent testing for acceptability, usability, sensitivity, reliability and validity, and have been accepted by the NHS Executive Committee for Regulating Information Requirements for entry in the NHS Data Dictionary. The scales also form part of the English Minimum Data Set for Mental Health.

The use of HoNOS is recommended by the English National Service Framework for Mental Health and by the working group to the Department of Health on outcome indicators for severe mental illnesses.

HoNOS is the most widely used routine clinical outcome measure used by English mental health services. The CRU conducted a survey of NHS mental health services in England in 2000 and found 34 services had implemented the use of HoNOS in one or more service settings. A further survey by the Department of Health in 2002 found that 61 trusts were using HoNOS in their services with 5 having implemented the use of the scales across the whole service.

HoNOS Training

More information on training: HoNOS Working Age Adults training (pdf)

HoNOS Supplies

The Royal College of Psychiatrists which developed HoNOS, provides the following to support its implementation HoNOS supplies order form (pdf)

  • Scoresheet An A4 sheet for recording background patient information and the HoNOS score.
  • Glossaries A small, handy folding reference guides for the rating of HoNOS.
  • Labels Self-adhesive score sheet labels to affix to case notes or other documents. There are nine labels on each A4 sheet. 
  • Final Report This is the final report which details the HoNOS research and development from July 1993 to December 1995. The report has three parts:- An executive summary; Five chapters detailing the design criteria specified by a panel of consultants, four phases of testing and the final conclusions and Five appendices that contain all other material needed for the use of HoNOS, such as the final HoNOS glossary, chart and score sheet, HoNOS trainers' guide and self-completion of HoNOS for patients.

Contact: Emma George via emma.george@rcpsych.ac.uk

The HIG65+ glossary is a tabulated verison of that originally published by the Royal College of Psychiatrists' College Research Unit. It had been refined and clarified between 1997 and 1999 by members of the HoNOS65+ Development Group of the former Lewisham & Guy's Mental Health NHS Trust; the first Trust to fully implement HoNOS65+.

These are 12 scales that are 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/or delusions or false beliefs
  • 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 - quality of day time environment

Each scale is rated as follows:

  1. No problem
  2. Minor problem that is non-clinical: i.e. would not normally lead to intervention
  3. Mild problem (that would justify intervention
  4. Moderate problem
  5. Severe problem

Contact: Emma George via emma.george@rcpsych.ac.uk

Health of the Nation Outcome Scales for Children and Adolescents was developed for children and adolescents (under the age of 18) in contact with mental health services. The use of HoNOSCA has been fully supported by the Department of Health and was employed in the Audit Commission survey of child and adolescent mental health services in 1998.

Contact: Emma George via emma.george@rcpsych.ac.uk

Background

HoNOS-secure version 2b is the latest version of what was previously known as HoNOS-MDO*.  It is specifically designed for use in health and social care settings such as secure psychiatric, prison health care and related forensic services, including those based in the community.  Parts of the original HoNOS can be hard to interpret in secure settings, and this scale meets that need.

In 2002, Dr Philip Sugarman and Lorraine Walker developed the first version of HoNOS-secure within St Andrew’s Group of Hospitals.  (St Andrew’s Group of Hospitals is now known as St Andrew’s Healthcare).  The ‘MDO scale’ was developed into 7 security scales so that the completed score sheet provided a profile of 19 severity ratings, a total HoNOS score and a separate security score.  The title was changed from ‘MDO’ (Mentally Disordered Offenders) to ‘secure’ to include all users of secure services.

HoNOS-secure version 2 was developed in late 2004 by simplifying the original instructions and making some changes to the wording of the security scales (based on detailed feedback from users and a review of rating reliability).  The aim was to create a more ‘user friendly’ tool. In version 2b, developed February 2007, the scales are unchanged but the instructions have been simplified based on feedback received at training sessions.

The 7 security rating scales are:

  • A = risk of harm to adults or children
  • B = risk of self-harm (deliberate or accidental)
  • C = need of building security to prevent physical escape
  • D = need for a safely staffed living environment
  • E = need for escort on leave (beyond the secure perimeter)
  • F = risk to individual from others
  • G = need for risk management procedures.

Like the previous versions, HoNOS-secure version 2b is not a risk assessment tool.  It allows the outcome of clinical risk assessment to be rated in terms of need for care and need for clinical risk management procedures.

*HoNOS-MDO consisted of an amended version of the 12 original HoNOS scales and a single ‘MDO scale’ that set out the overall need for level of secure care.  It was piloted by the Kent Forensic Psychiatric Service across Regional Secure Units in the South Thames Region.  Results showed a very high inter-rater reliability and also good reliability in using HoNOS and HoNOS-MDO interchangeably in those settings.

HoNOS-Secure glossary and scoresheet

Contact: Sanjith Kamath, Executive Medical Director via skamath@standrew.co.uk.

 

Introduction

Health of the Nation Outcome Scales for People with Learning Disabilities are designed for use with people with a learning disability with mental health needs irrespective of the degree of their disability. HoNOS-LD has been tested for inter-rater reliability, convergent reliability, validity to change and acceptability in a national pilot study. Results demonstrate a good inter-rater reliability and a level of sensitivity to change that was acceptable to clinicians working in the field.

Onsite training

Contact:   Emma George on 020 3701 2611 or via emma.george@rcpsych.ac.uk.

Background

Health of the Nation Outcome Scales for Acquired Brain Injury was derived largely from HoNOS65+ by a group of brain injury psychiatrists interested in developing a version HoNOS more suited for this group of people.

Contact: Dr Simon Fleminger, The Maudsley Hospital London via simon.fleminger@kcl.ac.uk.

2017

Ballesteros-Urpí A, Pardo-Hernández H, Ferrero-Gregori A, et al: Validation of the Spanish and Catalan versions of the Health of the Nation Outcome Scale for Children and Adolescent (HoNOSCA). Psychiatry Res 2018 Mar;261:554-559.

2011

Adamis, D., Giannakopoulou, D.F., Konstantopoulou, A., Michailidis, M. (2011) Translation and standardization of the HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents Scale in a Greek sample. Clin Child Psychol Psychiatry. 2011 Feb 11.

2010

Andreas, S., Harries-Hedder, K., Schwenk, W., Hausberg, M., Koch, U. & Schulz H. (2010) Is the Health of the Nation Outcome Scales appropriate for the assessment of symptom severity in patients with substance-related disorders. Journal of Substance Abuse Treatment;39 (1):32-40. Epub 2010 Apr 24.

Andreas, S., Harfst, T., Rabung, S., Mestel, R., Schauenburg, H., Hausberg, M., Kawski, S., Koch, U. & Schulz, H. (2010) The validity of the German version of the Health of the Nation Outcome Scales (HoNOS-D): a clinician-rating for the differential assessment of the severity of mental disorders.Int J Methods Psychiatr Res. 2010 Mar;19 (1):50-62.

Ausín, B., Muñoz, M. & Pérez-Santos, E. (2010) Development of the self-administered Spanish version of the Health of the Nation Outcome Scales for Older Adults: HoNOS65+A. Eur Psychiatry. Apr; 25 (3):164-71. Epub 2009 Jun 23.

Duke, B. (2010) HoNOS in the consultation liaison psychiatry setting: is it valid? Australas Psychiatry, Dec;18 (6):547-50.

Ganeshalingam, Y., Chang, D. & Dunn, N. (2010) The evidence for effective psychiatric admissions as measured by an audit of Health of the Nation Outcome Scales recording. J Eval Clin Pract. 2010 Feb; 16 (1):196-8.

Hanssen-Bauer, K., Langsrud, O., Kvernmo, S. & Heyerdahl, S. (2010) Clinician-rated mental health in outpatient child and adolescent mental health services: associations with parent, teacher and adolescent ratings. Child Adolescent Psychiatry Mental Health. 2010 Nov 25; 4:29.

Kisely, S., Campbell, L.A., Cartwright, J., Cox, M., & Campbell J. (2010) Do the Health of the Nation Outcome Scales measure outcome? Canadian Journal of Psychiatry. 2010 Jul; 55 (7):431-9.

Oiesvold, T., Bakkejord, T. & Sexton, J.A. (2010) Concurrent validity of HoNOS compared with a patient derived measure (SCL-90-R) in out-patient clinics. Psychiatry Res. Nov 20.

2009

Burgess, P., Trauer, T., Coombs, T., McKay, R. & Pirkis, J. (2009) What does 'clinical significance' mean in the context of the Health of the Nation Outcome Scales? Australas Psychiatry. 2009 Apr;17 (2):141-8.

Canuto, A., Rudhard-Thomazic, V., Herrmann, F.R., Delaloye, C., Giannakopoulos, P. & Weber, K. (2009) Assessing depression outcome in patients with moderate dementia: sensitivity of the HoNOS65+ scale. J Neurol Sci. 2009 Aug 15;283(1-2):69-72. Epub 2009 Mar 3.

Cheung, G. & Williams, G. (2009) Clinical utility of Health of the Nation Outcome Scales for older persons in a memory clinic. Australas Psychiatry. 2009 Apr; 17(2):149-55.

Meagher, D., O'Brien, S., Pullela, A., Oshun, A. & Brosnan, P. (2009) Multidisciplinary activities in a community mental health service: relationship to the Health of the Nation Outcome Scales scores and diagnosis. Psychiatric Bulletin 33, 172-175.

Stewart, M. (2009) Service user and significant other versions of the Health of the Nation Outcome Scales. Australas Psychiatry. 2009 Apr;17(2):156-63.

2008

Broersma, T.W. & Sytema, S. (2008) Implementation of the HoNOS65+.Tijdschr Psychiatr. 2008;50(2):77-82. Dutch.

2007

Andreas, S., Harfst, T., Dirmaier, J., Kawski, S., Koch, U. & chulz, H. (2007) A Psychometric evaluation of the German version of the 'Health of the Nation Outcome Scales, HoNOS-D': on the feasibility and reliability of clinician-performed measurements of severity in patients with mental disorders. Psychopathology. 2007;40(2):116-25.

Ausín, B., Muñoz. M., & Quiroga, M.A. (2007) Adaptación española de las escalas de resultados para personas mayores HoNOS65+ (Health of the Nation Outcome Scales for Older Adults). Revista española de geriatría y gerontología, 42 (2007), pp. 88–95.

Canuto, A. Weber, K. Gold, G. Notaridis, G. Michon, A. Giardini, U. Delaloye, C, Herrmann, F. & Giannakopoulos, P. (2007) Structured Assessment of Mental Health Status in Psychogeriatrics: Validity of the French HoNOS65+. The Canadian Journal of Psychiatry. 2007. 52:1.January.

Canuto, A., Weber, K., Gold, G., Notaridis, G., Michon, A., Giardini, U., Delaloye, C., Herrmann, F. & Giannakopoulos, P. (2007) Structured assessment of mental health status in psychogeriatrics: validity of the French HoNOS65+. Can J Psychiatry. 2007 Jan; 52(1):37-45.

Cheung, G. & Strachan, J. (2007) Routine 'Health of the Nation Outcome Scales for elderly people' (HoNOS65+) collection in an acute psychogeriatric inpatient unit in New Zealand. N Z Med J. 2007 Aug 10;120(1259):U2660.

Dickens G, Sugarman P and Walker L (2007) ‘HoNOS-secure: a reliable outcome measure for users of secure and forensic mental health services’. Journal of Forensic Psychiatry and Psychology 18:4, 507-514.

Gigantesco, A., Picardi, A. de Girolama, G. & Morosini, P. (2007) Discriminant Ability and Criterion Validity of the HoNOS in Italian Psychiatric Residential Facilities. Psychopathology. 2007; 40: 111-115.

Kisely S, Campbell L, Crossman D, Gleich S, Campbell J. (2007) Are The Health Of The Nation Outcome Scales A Valid And Practical Instrument To Measure Outcomes In North America? A three-site evaluation across Nova Scotia. Community Mental Health Journal. 43: 91-107.

Lesinskiene, S., Senina, J. & Ranceva, N. (2007) Use of the HoNOSCA scale in the teamwork of inpatient child psychiatry unit. J Psychiatr Mental Health Nurs. 2007 Dec; 14 (8):727-33.

Phuaphanprasert, B., Srisurapanont, M., Silpakit, C., Pannarunothai, S., Udomratn, P., Geater, A. & Prapaphomrn, P. (2007) Reliability and validity of the Thai version of the Health of the Nation Outcome Scales (HoNOS). J Med Assoc Thai. 2007 Nov; 90 (11):2487-93.

2006

Bech, P. Bille, J. Waarst, S. Wiese, M. Borberg, L. Treufeld, P. & Kessing, L. (2006) Validity of HoNOS in identifying frequently hospitalised patients with ICD-10 mental disorders. Acta Psychiatr Scand. 113:485-491.

Burgess, P., Pirkis, J. & Coombs, T. (2006) Do adults in contact with Australia’s public sector mental health services get better? Australia and New Zealand Health Policy. 3:9.

Hansen, L. & Kingdon, D. (2006) Rating Suicidality in Schizophrenia: Items on Global Scales (HoNOS and CPRS) Correlate with a Validated Suicidality Rating Scale (InterSePT). Archives of Suicide Research. 10:249-252.

Macgregor, A.C. & Sheerin, D. (2006) Family Life and Relationships in the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Psychiatric Bulletin. 30, 216-219.

Schneider, J., Brandon, T., Carpenter, J. & Paxton, R. (2006) Assertive Outreach: policy and reality. Psychiatric Bulletin. 30, 89-94.

2005

Fleminger, S., Leigh, E., Eames, P., Langrell, L., Nagraj, R. & Logsdail, S. (2005) HoNOS-ABI: a reliable outcome measure of neuropsychiatric sequelae to brain injury? Psychiatric Bulletin, 29, (2): 53-55.

Harnett, P.H., Loxton, N.J., Sadler, T., Hides, L. & Baldwin, A. (2005) The Health of the Nation Outcome Scales for Children and Adolescents in an adolescent in-patient sample. Aust N Z J Psychiatry. 2005 Mar;39(3):129-35

Leach, C., Lucock, M., Barkham, M., Noble, R., Clarke, L. & Iveson, S. (2005) Assessing risk and emotional disturbance using the CORE-OM and HoNOS outcome measures at the interface between primary and secondary mental healthcare. Psychiatric Bulletin, 29, 419-422.

Marke, C., Leigh, E. & Fleminger, S. (2005) HoNOS-ABI: an under-utilised resource? Psychiatric Bulletin, 29:35. (Correspondence)

Parabiaghi, A. Barbato, A. D’Avanzo, B. Erlicher, A. & Lora, A. (2005) Assessing reliable and clinically significant change on Health of the Nation Outcome Scales: method for displaying longitudinal data. Australian and New Zealand Journal of Psychiatry. 39:719-725.

Pirkis, J.E., Burgess, P.M., Kirk, P.K., Dodson, S., Coombs, T.J. & Williamson, M.K. (2005) A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health Qual Life Outcomes. 2005 Nov 28;3:76

Salvi, G., Leese, M. & Slade, M. (2005) Routine use of mental health outcome assessments: choosing the measure. British Journal of Psychiatry, 186: 146-152.

Simpson, K., Coombs, T. & Avery, A. (2005) Introducing the health of the nation outcomes scales into undergraduate nurse preparation: opportunities for development - a pilot project.Nurse Educ Pract. 2005 Mar;5(2):97-102.

2004

D'Avanzo, B., Battino, R.N., Gallus, S. & Barbato, A. (2004) Factors predicting discharge of patients from community residential facility: a longitudinal study from Italy. Aust N Z J Psychiatry, 38 (8): 619-28.

Ecob, R., Croudace, T.J., White, I.R., Evans, J.E., Harrison, G.L., Sharp, D. & Jones, P.B. (2004) Multilevel investigation of variation in HoNOS ratings by mental health professionals: a naturalistic study of consecutive referrals. International Journal Methods Psychiatry Research, 13 (3): 152-64.

Fisher, L.J., Goldney, R.D., Furze, P.F., Mattner, J. & McCleave, D.J. (2004) Electroconvulsive therapy, depression and cognitive outcomes: an Australian audit. Journal of ECT. 20 (3): 174-8.

James, M. & Mitchell, D. (2004) Measuring health and social functioning using HoNOS. In Harrison, M., Howard, D. & Mitchell, D. (Eds) Acute Mental Health Nursing, 29-50.

Page, A.C. & Hooke, G.R (2004) Failure to replicate the effects of gender and season on the length of hospitalisation in unipolar depressives. Journal Affect Disorder, 81 (3): 275-8.

Reilly, S., Challis, D., Burns, A. & Hughes, J. (2004) The use of assessment scales in Old Age Psychiatry Services in England and Northern Ireland. Aging Mental Health, 8 (3): 249-55.

Rodenberg, H., Bos, V., O'Malley, C., McGeorge, P., Love, T. & Dowell, A. (2004) General Practice care of enduring mental health problems: an evaluation of the Wellington Mental Health Liaison Service. N Z Med J. 117 (1202): U1077.

Turner, S. (2004) Are the Health of the Nation Outcome scales (HoNOS) useful for measuring outcomes in older people's mental health services? Aging Mental Health, 8 (5): 387-96.

2003

Bech, P., Bille, J., Schutze.T., Sondergaard, S., Wiese, M. & Waarst, S. (2003) Health of the Nation Outcome Scales (HoNOS): Implementability, subs structure and responsiveness in the daily psychiatric hospital routine over the first 18 months. Nord J Psychiatry, 57 (4): 285-90.

Bilenberg, N. (2003) Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) - results of a Danish field trial. Eur Child Adolescent Psychiatry, 12 (6): 298-302.

Huxley, P., Reilly, S., Robinshaw, E., Mohamad, H., Harrison, J., Windle, B. & Butler, T. (2003) Interventions and outcomes of health and social care service provision for people with severe mental illness in England. Social Psychiatry and Psychiatric Epidemiology, 38 (1): 44-48.Kennedy, C.& Yellowlees, P. (2003) The effectiveness of telepsychiatry measured using the Health of the Nation Outcome Scale and the Mental Health Inventory. J Telemed Telecare, 9 (1): 12-6.

Lelliott, P. (2003) Secondary uses of patient information. Advances in Psychiatric Treatment, 9: 221-228.

Morosini, P., Gigantesco, A., Mazzarda, A. & Gibaldi, L. (2003) HoNOS-Rome: an extended, customized and longitudinal oriented version of the HoNOS. Epidemiol Psichiatr Soc, 12 (1): 53-62.

Percudani, M., Gerzeli, S., Massagrandi, R., Jommi, C., Fattore, G., Cerati, G. & Contini, A. (2003) Costs and outcome of care in subjects with severe mental disorders. Epidemiol Psichiatr Soc, 12 (3): 175-86.

2002

Arrighi, E., Baj, G., Bezzi, R., Civenti, G., Di Maio, A., Erlicher, A., Farinazzo, C., Lora, A., Mapelli, V., Miragoli, P., Monzani, E., Panetta, B., Ravasio, R., Von Morghen, D. & Torri, V. (2002) Pattern Di Trattamento E Costi Nei Dipartimenti Di Salute Mentale Della Regione Lombardia. Il Progetto di Ricerca HoNOS 2. Epidemiologia E Psichiatria Sociale, 4, Vol 11.

Bezzi, R., Farinazzo, C. & Miragoli, P. (2002) Bibliografia Ragionata Della Scala HoNOS. Epidemiologia-e-Psichiatria-Sociale, 11/SUPPL. 5, 15-32.

Bonsack, C., Borgeat, F. & Lesage, A. (2002) Mesurer La Severite Des Problemes Des Patients Et Leur Evolution dans un Secteur Psychiatrique: Une Etude Sur Le Terrain Du Health of Nation Outcome Scales en Francais (HONOS-F). Annales-Medico-Psychologiques, 160/7, 483-488.

Corrigall,R. & Mitchell, B. (2002) Service innovations: Rethinking in-patient provision for adolescents: A report from a new service. Psychiatric-Bulletin, Vol 26 (10): 388-392.

Gilbody, S.M., House, A.O., Sheldon, T.A. (2002) Psychiatrists in the UK do not use outcome measures: National Survey. Psychiatric Bulletin, 180 (2): 101-103.

Gilbody, S.M., House, A.O., Sheldon, T.A. (2002) Outcome research in mental health. Psychiatric Bulletin, 181, 8-16.

Gowers, S.G., Levine, W., Bailey-Rogers, S., Shore, A., & Burhouse, E. (2002) Use of a routine, self-report outcome measure (HoNOSCA-SR): in two adolescent mental health services. The British Journal of Psychiatry, 180, 266-269.

Holloway, F. (2002) Outcome measurement in mental health - welcome to the revolution. The British Journal of Psychiatry, 181, 1-2.

Hugo, M., Smout, M. & Bannister, J. (2002) A comparison in hospitalisation rates between a community -based mobile emergency service and a hospital-based emergency service. The Australian and New Zealand journal of psychiatry, 36 (4): 504-8.

James, M. (2002) The use of Health of the Nation Outcome Scales (HoNOS) in routine clinical practice by NHS mental health service providers in England: A summary of findings. The Approach, 23.(CPAA)

Lambert, G., Caputi, P. & Deane,F.P. (2002) Sources of information when rating the Health of the Nation Outcome Scales. International Journal of Mental Health Nursing, Vol 11 (2): 135-138.

Macdonald, A. (2002) The usefulness of aggregated routine clinical outcomes data: the example of HoNOS65+. Journal of Mental Health, 11, 645-656.

McEvoy, P., Colgan, S. & Richards, D. (2002) Gatekeeping access to community mental health teams: differences in practice between consultant psychiatrists, senior house officers and community psychiatric nurses. Psychiatric Bulletin, 26 (2): 56-58.

Page, A., Hooke,G. & Rutherford, E. (2002) Reply to Dr Stafrace. Australian and New-Zealand Journal of Psychiatry, Vol 36(4): 558-559.

Parker, G., O’Donnell, M., Hadzi-Pavlovic, D. & Proberts, M. (2002) Assessing outcome in community mental health patients: a comparative analysis of measures. International Journal of Social Psychiatry, 48 (1): 11-19.

Rossi, F. (2002) Pattern Di Trattamento E Costi Nei Dipartimenti Di Salute Mentale Della Regione Lombardia: IL progetto Di Ricerca HoNOS 2: Presentazione. Epidemiologia-e-Psichiatria-Sociale, 11/SUPPL, 5, V-VIII.

Roy, A., Matthews, H., Clifford, P., Fowler, V., & Martin, D. (2002) Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD). British Journal of Psychiatry, 180, 61-66.

Roy, A., Matthews, H., Clifford, P., Fowler, V., & Martin, D. (2002) Health of the Nation Outcome Scales for People with Learning Disabilities (HoNOS-LD). Glossary for HoNOS-LD score sheet. British Journal of Psychiatry, 180, 67-70.

Sanderson, K. & Andrews, G. (2002) Prevalence and severity of mental health - related disability and relationship to diagnosis . Psychiatric Services, 53 (1) : 80-86.

Smith,D., Fisher, L. & Goldney, R. (2002) Do suicidal ideation and behaviour influence duration of psychiatric hospitalization? International Journal of Mental Health Nursing, Vol 11 (4): 220-224.

Spear, J., Chawla, S., O'Reilly, M. & Rock, D. (2002) Does the HoNOS65+ meet the criteria for a clinical outcome indicator for mental health services for older people? International Journal of Geriatric Psychiatry, 17 (3): 226-230.

Stafrace, S. (2002) Doubts about HoNOS. Australian and New-Zealand Journal of Psychiatry, Vol 36 (2): 270.

Trauer, T. & Callaly, T. (2002) Concordance between patients and their case managers using Health of the Nation Outcome Scales (HoNOS) . Australasian Psychiatry, 10/1 (24-28).

Trauer, T., Coombs, T. & Eagar, K. (2002)Training in routine mental health outcome assessment: the Victorian experience. Australian Health Review, Vol. 25 (2): 122-128. Download a copy

Trauer, T., Coombs, T. & Eagar, K. (2002)Training in routine mental health outcome assessment: an evaluation of the Victorian experience. Australian Health Review, Vol. 25 (3): 74-82. Download a copy

2001

Audin, K., Margison, F.R., Clark, J.M. & Barkham, M. (2001) Value of HoNOS in assessing patient change in NHS psychotherapy and psychological treatment services. British Journal of Psychiatry, 178: 561-6.

Brann, P., Coleman, C. & Luk, E (2001) Routine outcome measurement in a child and adolescent mental health service: an evaluation of HoNOSCA. Australian and New Zealand Journal of Psychiatry, 35: 370-376.

Broadbent, M. (2001) Reconciling the information needs of clinicians, managers and commissioners - a pilot project. Psychiatric Bulletin, 25, 423-425.

Coetzer, R., Du Toit, P.L. (2001) HoNOS-ABI; a clinically useful outcome measure? Psychiatric Bulletin, 25 (11): 421-422.

Lauzon, S., Corbiere, M., Bonin, J.P., Bonsack, C., Lesage, A.D. & Ricard, N. (2001) Validation de la version francaise du Health of the Nation Outcome Scales (HoNOS-F). Canadian Journal of Psychiatry, 46 (9): 841-46. (French)

Lora, A., Bai, G., Bianchi, S., Bolongaro, G., Civenti, G., Erlicher, A., Maresca, G., Monzani, E., Panetta, B., Von Morgen, D., Rossi, F., Torri, V. & Morosini, P. (2001) La Versione Italiana Della HoNOS (Health of the Nation Outcome Scales), Una Scala Per La Valutazione Della Gravita E Dell'Esito Nei Servizi Di Salute Mentale. Epidemiologia E Psischiatria Sociale, 10, (3) 198-212.

Milne, D., Reichelt, K. & Wood, E. (2001) Implementing HoNOS: An Eight Stage Approach. Clinical Psychology and Psychotherapy, 8, 106-116.

Page, A., Hooke, G., Rutherford, E. (2001) Measuring mental health outcomes in a private psychiatric clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36. Australian and New Zealand Journal of Psychiatry, 35 (3): 377-381.

Wilcock, A. (2001) The use of HoNOS in a low secure in-patient setting. The Approach, 19, 15-16. Care Programme Approach Association.

2000

Adams, M., Palmer, A., O'Brien, J.T. & Crook, W. (2000) Health of the Nation Outcome Scales for psychiatry: Are they valid? Journal of Mental Health, 9 (2): 193-198.

Bagley, H., Cordingley, L., Burns, A., Mozley, C.G., Sutcliffe, C., Challis, D. & Huxley, P. (2000) Recognition of depression by staff in nursing and residential homes. Journal of Clinical Nursing, 9 (3): 445-450.

Brooks, R. (2000) The reliability and validity of the Health of the Nation Outcome Scales: Validation in relation to patient derived measures. Australian & New Zealand Journal of Psychiatry, 34 (3): 504-511.

Browne, S., Doran, M. & McGauran, S. (2000) Health of the Nation Outcome Scales (HoNOS): Use in an Irish psychiatric outpatient population. Irish Journal of Psychological Medicine, 17 (1): 17-19.

Cheah, Y.C., Parker, G. & Roy, K. (2000) Evaluation and validation of a measure profiling needs and problems of psychiatric patients in the community: a Malaysian study. Social Psychiatry & Psychiatric Epidemiology, 35 (4): 170-6.

Gallagher, J. & Teeson, M. (2000) Measuring disability, need and outcome in Australian community mental health services. Australian & New Zealand Journal of Psychiatry, 34 (5): 850-855.

Garralda, M.E., Yates, P. & Higginson, I. (2000) Child and adolescent mental health service use. HoNOSCA as an outcome measure. British Journal of Psychiatry, 177:52-8.

Glover, G.R., Sinclair-Smith, H. (2000) Computerised information systems in English mental health care providers in 1998. Social Psychiatry and Psychiatric Epidemology, 35 (11): 518-522.

Hatfield, B., Spurrell, M., & Perry, A. (2000) Emergency referrals to an acute psychiatric service: demographic, social and clinical characteristics and comparisons with those receiving continuing services. Journal of Mental Health, 9 (3): 305-17.

Keys, R. (2000) HoNOS: does it have a role to play in mental health services? Mental Health Practice, 3 (7): 22-24.

McClelland, R., Trimble, P., Fox, M.L., Stevenson, M.R. & Bell, B. (2000) Validation of an outcome scale for use in adult psychiatric practice. Quality in Health Care, 9 (2): 98-105.

Preston, N.J. (2000) The Health of the Nation Outcome Scales: Validating factorial structure and invariance across two health services. Australian & New Zealand Journal of Psychiatry, 34 (3): 512-519.

Rushforth, D., Brooker, C., Winstanley, J. & Repper, D. (2000) The use of HoNOS in the evaluation of partial hospitalisation in mental health day care. Health of the Nation Outcome Scales. Clinical Effectiveness in Nursing, 4 (3): 121-127.

Slade, M., Thornicroft, G., Beck, A., Bindman, J. & Wright, S. (2000) Assessment: from Theory to Practice. British Journal of Psychiatry, 176, 394-395.

Trauer, T. (2000) Update from Down Under. British Journal of Psychiatry, 176, 393- 394.

Trauer, T. (2000) Comment. Australian & New Zealand Journal of Psychiatry, 34 (3): 520-521.

Wing, J.K., Lelliott, P., & Beevor, A.S. (2000) Progress on HoNOS. British Journal of Psychiatry, 176, 392-393.

1999

Allen, L., Bala, S., Carthew, R., Daley, S., Doyle, E., Driscoll, P., et al. (1999) Experience and application of HoNOS65+. Psychiatric Bulletin, 23, 203-206.

Amin, S., Singh, S.P., 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. The British Journal of Psychiatry, 174, 399-403.

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, 174, 389-394.

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, E.R., Lawton, K., Watson, M.S. & Palin, A.N. (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, 174, 435-438.

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, 174, 424-427.

Chaplin, R. & Perkins, R. (1999) HoNOS: A cautionary tale of their use in a rehabilitation service. Psychiatric Bulletin, 23 (1): 20-21.

Charlwood, P., Mason, A., Goldacre, M., Cleary, R. & Wilkinson, E. (eds) (1999) Health Outcome Indicators: Severe Mental Illness. Report of a working group to the Department of Health. Oxford: National Centre for Health Outcomes Development.

Culiford, L., Goff-Beardsley, S. & Atkinson, T. (1999) Usefulness of HoNOS. Psychiatric Bulletin, 23 (9): 571.

Dalal, B., Larkin, E., Leese, M. & Taylor, P.J. (1999) Clozapine treatment of long-standing schizophrenia and serious violence: A two-year follow-up study of the first 50 patients treated with clozapine in Rampton high security hospital. Criminal Behaviour & Mental Health, 9 (2): 168-178.

Gowers, S.G., Harrington, R.C., 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, 174, 413-416.

Gowers, S.G., Harrington, R.C., Whitton, A., Beevor, A., Lelliott, P., Jezzard, R. & Wing, J.K. (1999) Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): Glossary for HoNOSCA score sheet. The British Journal of Psychiatry, 174, 428-431.

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.

MacDonald A.J.D. (1999) HoNOS 65+ glossary. British Journal of Psychiatry, 175, 192.

Mozley, C.G., 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, 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.

Rossi, F., Blaco, R., Castelli, C., Civenti, G., Cocchi, A., Contini, A., Erlicher, A., Lanzara, D., Lora, A., Marcandalli, S., Morosini, P., & Pisapia, D. (1999) Cost of psychiatric patients by disability groups. EPIDEMIOL PSYCHIATR SOC, 8 (3): 198-208. (Italian)

Salvador-Carulla, L. (1999) Routine outcome assessment in mental health research. Current Opinion in Psychiatry, 12, 207-210.

Sharma, V.K., Wilkinson, G. & Fear, S. (1999) Health of the Nation Outcome Scales: a case study in general psychiatry. British Journal of Psychiatry, 174, 395-398.

Shergill, S.S., Shankar, K.K., Seneviratna, K. & Orrell, M.W. (1999) The validity and reliability of the Health of the Nation Outcome Scales (HoNOS) in the elderly. Journal of Mental Health, 8 (5): 511-521.

Slade, M., Beck, A., Bindman, J., Thornicroft, G. & Wright, S. (1999) Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS. The British Journal of Psychiatry, 174, 404-408.

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, 174, 380-388.

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, J.K., Curtis, R.H. & Beevor, A.S. (1999) Health of the Nation Outcome Scales (HoNOS): Glossary for HoNOS score sheet. The British Journal of Psychiatry, 174, 432-434.

Wing, J.K., Curtis, R.H. & Beevor, A.S. (1999) Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Glossary for HoNOS score sheet. The British Journal of Psychiatry, 174, 432-434.

Wing, J., Lelliott, P. & Chaplin, R.H. (1999) Reliability and validity of HoNOS (multiple letters). Psychiatric Bulletin, 23 (6):375.

Yates, P., Garralda, M.E. & Higginson, I. (1999) Paddington Complexity Scale and Health of the Nation Outcome Scales for Children and Adolescents. The British Journal of Psychiatry, 174, 413-416.

1998

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. & Rigby, E. (1998) HoNOS in long-stay patients with learning disabilities. Psychiatric Bulletin, 22 (5): 306-308.

Blair, G. & Deaney, C. (1998) Inner-city general practice population of people with schizophrenia. Psychiatric Bulletin, 22 (4): 221-225.

Cheah, Y.C., 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.

Goldney, R.D., Fisher, L.J. & Walmsley, S.H. (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.

Wing, J.K., Beevor, A.S., Curtis, R.H., Park, S.B.G., Hadden, S. & Burns, A. (1998) Health of the Nation Outcome Scales (HoNOS): Research and development. British Journal of Psychiatry, 172, 11-18.

1997

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.

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.

Boot, B., Hall, W. & Andrews, G. (1997) Disability, outcome and case-mix in acute psychiatric in-patient units. British Journal of Psychiatry, 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.

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.

Taylor, J.R. & Wilkinson, G. (1997) HoNOS vs GP opinion in a shifted out-patient clinic. Psychiatric Bulletin, 21 (8): 483-485.

1996

Carlisle, D. (1996) Economies of scales. Nursing Times, 92 (50): 38-39.

Goldney, R.D., Fisher, L.J., Walmsley, S., Kent, P. & Cooper, A.W. (1996) A pilot study of the Health of the Nation Outcome Scale as a measurement of outcome in a private psychiatric hospital. Australasian Psychiatry, 4 (6): 319-321.

Jeffries, M. (1996) A culture of effective efficiency. NHS Magazine. Autumn (6): 12-13.

Wing, J.K., Curtis, R.H. & Beevor, A.S. (1996) HoNOS: Health of the Nation Outcome Scales: Report on Research and Development July 1993-December 1995. London: Royal College of Psychiatrists.

  • Health of the Nation Outcome Scales (HoNOS) © Royal College of Psychiatrists 1996
  • Health of the Nation Outcome Scales (HoNOS 2018) © Royal College of Psychiatrists 2018
  • Health of the Nation Outcome Scales for Elderly People (HoNOS 65+) © Royal College of Psychiatrists 1999
  • Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) © Royal College of Psychiatrists 1999
  • Health of the Nation Outcome Scales for Acquired Brain Injury (HoNOS ABI) © Royal College of Psychiatrists 1999

Copyright statement

Copyright in the Health of the Nation Outcome Scales (HoNOS, HoNOS 65+, HoNOSCA and HoNOS ABI) is owned by the Royal College of Psychiatrists. Commercial copying, renting, and adaptation are prohibited.

Copyright guidance

The following acts may not be performed without the consent of the Royal College of Psychiatrists:

  • Copying the work
  • Renting or otherwise issuing copies of the work to the public.
  • Adapting the work [e.g. changes to the wording of items, scaling of items, addition or deletion of items or changes in the order of items].

This guidance is intended to clarify what extensions to the conditions the Royal College of Psychiatrists (RCPsych) will allow and under what circumstances they expect to be approached to gain explicit permission.

Where HoNOS is used copyright should be acknowledged with the following statement:

Health of the Nation Outcome Scales (HoNOS) © Royal College of Psychiatrists 1996

The HoNOS glossary

The RCPsych does not permit the reproduction or copying of the HoNOS glossary. All organisations or individuals should seek permission from the RCPsych to reproduce the glossaries or include the glossary descriptions within electronic health records.

HoNOS scoresheets

The RCPsych allows without express permission the free use, copy and reproduction of HoNOS scoresheets for use in NHS-funded care. Use, copy or reproduction of HoNOS scoresheets for any other purpose should be with the explicit permission of the RCPsych.

The RCPsych allows without express permission NHS organisations and other providers of NHS funded care to include HoNOS scoresheets in electronic healthcare records and other computerised clinical systems.

Where possible, original fonts and layouts should be used. The inclusion of HoNOS within commercial ‘for profit’ software systems will require the explicit permission/license of the RCPsych.

Written HoNOS training materials

The RCPsych allows the copying and reproduction of training materials supplied as part of its accredited training only within the organisations who have commissioned that training. All other organisations should seek the explicit permission of the RCPsych to undertake any reproduction, issuing copies to the public or making adaptations in any way.

Training DVD/video

Permissions should be sought from the RCPsych for any reproduction, rental, lending or adaptation of the Training DVD. The use of the training DVD is permitted by accredited trainers and organisations who have commissioned training for trainers. All other commercial or public exhibition of the DVD is prohibited without the express permission of the RCPsych.

Other HoNOS publications

The permission of the RCPsych should be sought to undertake any acts associated with copyright law in relation to any other HoNOS publications of the RCPsych.

Contact:  special_sales@cambridge.org

Contact for Australia: Rosemary Dickson,  Network Coordinator, Australian Mental Health Outcomes and Classification Network (AMHOCN) on Rosemary.Dickson@health.nsw.gov.au or Tim Coombs, AMHOCN Consultant on timcoombs@live.com.au

About the Mental Health Clustering Tool

The MHCT has been developed in partnership between the Department of Health, the Royal College of Psychiatrists Centre for Advanced Learning and Conferences and the Care Pathways and Packages Project (CPPP) as a means of allocating clients to Care Clusters which in turn supports care planning and enables Mental Health Payment by Results (MH PbR). The MHCT retains the Health of the Nation Outcome Scales (HoNOS) and thus supports providers and commissioners in measuring health and social care outcomes in mental health without the need to collect additional data.

HoNOS was published by the Royal College of Psychiatrists (RCPsych) in 1996 and is now the most widely used outcome measure in specialist mental health services in England and overseas. The RCPsych has over 20 years experience of training clinical staff in the use of the HoNOS, working with staff teams to train them as trainers and with Trusts to develop and support Trust wide training and implementation plans.

MHCT training

To support mental health service providers and commissioners in implementing MH PbR, the following training courses are available:

  • Mental Health Clustering Tool – Foundation One Day Training Course. Delivered directly to all staff who will be involved in assessment and clustering
  • Mental Health Clustering Tool – Train the Trainers Two Day Course. Designed to help organisations train staff and implement MHCT . For organisations which have no previous experience of using HoNOS
  • Mental Health Clustering Tool – Train the Trainers Course One Day Update Course. Designed to help organisations train staff and implement MHCT. For organisations which HAVE previous experience of using HoNOS
  • Bespoke courses on request to suit your specific organisational needs (NB. HoNOS only training courses are available on request)

More information on training: Mental Health Clustering Tool (pdf)

Contact: Emma George on emma.george@rcpsych.ac.uk

Get in contact to receive further information regarding a career in psychiatry