Mental Health Nursing

38 Acute Mental Health Nursing
A glossary provides information on each of the items and examples of
current ‘health’ status for each of the points on the severity scale.
The 12 HoNOS items
1. Overactive, aggressive, disruptive or agitated behaviour.
2. Non-accidental self-injury.
3. Problem drinking or drug-taking.
4. Cognitive problems.
5. Physical illness or disability problems.
6. Problems associated with hallucinations and delusions.
7. Problems with depressed mood.
8. Other mental and behavioural problems.
9. Problems with relationships.
10. Problems with activities of daily living.
11. Problems with living conditions.
12. Problems with occupation and activities.
Since HoNOS contains 12 items which are each scored from 0 to 4 on the
severity scale, the range of total scores is 0 to 48. As well as the individual
item and total scores, the scale provides four sub-scales.
Section A – Behavioural problems (3 items).
Section B – Impairment problems (2 items).
Section C – Symptomatic problems (4 items).
Section D – Social problems (4 items).
Because the sub-scales are made up of different numbers of item scores,
the sub-scale ranges are not all the same.
Uses of HoNOS in an in-patient setting
HoNOS provides a simple and easy-to-use tool for the measurement of
outcome within an acute in-patient setting. It is usual for HoNOS ratings
to be carried out shortly after admission and again just prior to discharge.
On each of these occasions, the rating is based on the problems experienced
by that individual during the previous two weeks, the difference
between the two ratings at admission and discharge thus forming the measure
of outcome.
This model of using the tool does work on the presumption that the
individuals’ period of in-patient treatment is reasonably short. Where
individuals remain in-patients for significant periods of time it would be
beneficial to undertake intermediate ratings during the stay to assess the
ongoing outcome and provide a measurement of trends for that individual