Mental Health Nursing

have timely, accurate and appropriate access to the mental health information
they need’ (Department of Health, 2001: 3). This document has, at its
heart, the intention of improving how information is collated and used
within Mental Health services and maps out the actions necessary to
achieve the information requirements of the National Service Framework
for Mental Health (Department of Health, 1999) and Information for Health
(Secretary of State, 1998). HoNOS is identified as the key outcome
indicator, which as part of an MHMDS can help to meet the goal of providing
‘quality and management information to aid continuous service
improvement’ (Department of Health, 2001: 30). It is clear, therefore, that
HoNOS will become a necessary part of data collection and performance
management for mental health services in the UK for the foreseeable
future. The challenge for mental health professionals is to ensure that it
is used appropriately to provide useful, timely, quality data for managing
client caseloads and targeting activities and resources to meet
client needs.
What is HoNOS?
Measuring health and social functioning using HoNoS 35
HoNOS is a short, simple set of scales that provides a profile and measure
of the severity of an individual’s behavioural, impairment and mental
health problems as well as their current social functioning. The scales are
designed for use in any setting in secondary mental health care services and
are based on a rating of the worst symptoms/problems that have occurred
during the previous two-week period. As HoNOS was principally designed
as a health outcome measure, ratings have to be made on at least two occasions
in order to determine whether an individual has improved, deteriorated
or stayed the same over the intervening period. When more than two
ratings are made it then provides a means of examining trends over time,
both for individuals and groups of individuals.
The scales cover a broad range of elements that constitute health and
social functioning and are intended to be completed in a few minutes by
clinicians after routine clinical assessments (most usually at CPA reviews
or ward rounds). The rating thus obtained provides a brief numerical record
of the clinical assessment in terms of the current health and social functioning
of the individual. Once two ratings have been made for an individual,
the differences between the levels of severity provide a measure of
outcome, but it is important to note that this is a measure of mental health
outcome for that individual, not the health care outcomes as a result of the
care and treatment provided.
HoNOS provides a standard record of progress across 12 common
types of problem. Once the scores have been recorded they provide a