Routine clinical outcome measures for patients with severe mental illness: CANSAS and HoNOS

Abstract

CANSAS and HoNOS assessments differ. HoNOS can track changes in social functioning over time, but may be less useful for treatment planning, and should not be used to infer the level of morbidity in a case-load. CANSAS indicates when treatment should be commenced or continued. It can also be used as a case-load measure, but may be insufficiently sensitive to be used as an outcome measure at the individual level.

Use of Health of the Nation Outcome Scales in psychiatry

“…Outcome measurements in mental health have some value in monitoring the progress of indi vidual patients, auditing and determining effectiveness of policy (Slade 1999). There has therefore been a major drive to introduce outcome measurement in healthcare over the past two decades.…”

“…He also cited 'intrusion' into valuable clinician-patient time as a potential hurdle. Slade (1999) and colleagues argued that assessing morbidity and identifying specific areas for ongoing intervention in an existing caseload and thus differentiating between met needs and no needs would not be possible with HoNOS alone. They recommend using HoNOS with another scale for ongoing interventions to assess unmet needs.…”

Individual unmet needs for care: are they sensitive as outcome criterion for the effectiveness of mental health services interventions?

“…This is rather surprising and possibly an underestimated phenomenon. Wennström and Wiesel [29] observed over a period of six years that the mean number of (unmet) needs did not change much (about 6.3 for total and 1.5 for unmet needs), most (82%) needs in 1997 were (still) met or had disappeared in 2003…”

“…seems hardly linked to number or kind of interventions [6,8,15,23,29]; although with some exception, see Salize et al [24]. One out of two to four needs appears to be unmet, in particular in the areas of psychological distress, daytime activities, social contacts, and psychotic symptoms.…”

“…Further, most authors compare summary scores of total number of met and unmet needs, while Wennström and Wiesel [29] argue that this might be misleading by concealing changes on an individual need level. They demonstrate that while no change over a period of six years occurred in summary scores of the Camberwell Assessment of Needs (CAN), significant changes in need status on nearly all items were found and mostly in the favorable direction: remaining needs were more often met than not and many patients in need of care or support in 1997 appeared to be managing on their own without problems in 2003.…”