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Objective: The primary aim of the Scottish Schizophrenia Outcomes Study (SSOS) was to assess the feasibility and utility of routinely collecting outcome data in everyday clinical settings. Data were collected over three years in the Scottish National Health Service (NHS). There were two secondary aims of SSOS: first, to compare data from patient-rated, objective, and clinician-rated outcomes, and second, to describe trends in outcome data and service use across Scotland over the three years of the study (2002-2005). Methods: This study used a naturalistic, longitudinal, observational cohort design. A representative sample of 1,015 persons with lCD-10 F20-F29 diagnoses (schizophrenia, schizotypal disorders, or delusional disorders) was assessed annually using the clinician-rated measure, the Health of the Nation Outcome Scale (HoNOS), and the patient-reported assessment, the Avon Mental Health Measure (Avon). Objective outcomes data and information on services and interventions were collected. Data were analyzed with regression modeling. Results: Of the 1,015 persons recruited, 78% of the cohort (N= 789) completed the study. Over the study period, significant decreases were seen in the number of hospitalizations, incidence of attempted suicide and self-harm, and civil detentions. Avon scores indicated significant improvement on all subscales (behavior, social, access, and mental health) and on the total score. However, HoNOS scores on the behavior and symptom subscales did not change, scores on the impairment subscale increased significantly (indicating increased levels of impairment), and scores on the social subscale decreased significantly (indicating improved social functioning). Conclusions: This study has demonstrated that it is feasible within the Scottish NHS to routinely collect meaningful outcomes data in schizophrenia. Patient-reported assessments were also successfully collected and used in care plans. This model shows that it is possible to incorporate patient-reported assessments into routine care for schizophrenia. Such assessments may provide useful data for clinicians and may improve treatment adherence. The pattern of outcomes and interventions confirms that despite the introduction of guidelines, new treatments, and new services, people with schizophrenia continue to have high levels of chronic disability. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Greater Glasgow Health Board’s strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow. [ABSTRACT FROM AUTHOR]