The use of the Health of the Nation Outcome Scales (HoNOS) to inform discharge and transfer decisions in community mental health services

Abstract

Discharge from public community mental health services has proven difficult for mental health workers and managers. Mental illness can often be long term, with ongoing disability, requiring a need for corresponding long-term care. Community mental health services are now becoming recovery focused and are recognising the need for alternative management arrangements for individuals with long-term care needs. There are, however few tools to assist in the decision making about discharge or transfer of care between community mental health teams. This article describes a quality improvement project to develop a flag for mental health workers to prompt decisions regarding discharge and transfer using the Health of the Nation Outcome Scales (HoNOS). Relevant literature and HoNOS data collected as part of routine clinical practice were reviewed to develop the flag. The implementation process is described along with plans for future developments.

Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN)

“…More importantly, clinicians and consumers have come to value outcome data, albeit to varying degrees [17,18]. In addition, there are examples of outcome data being used in local service settings to guide clinical decision-making, engage consumers in treatment, foster a collaborative approach to care planning and goal setting, review consumers’ progress with treatment, inform questions about consumers’ eligibility for given programs, assist with discharge planning, improve the evidence-base on which services are founded, and evaluate particular models of service delivery [19,20]. Casemix development has not proceeded at the same pace as routine outcome measurement, but some progress has been made.…”

Use of Health of the Nation Outcome Scales in psychiatry

“…In an illustrative example, Prowse & Coombs (2009) describe the implementation of a flag system based on HoNOS scores to prompt decisions regarding discharge/transfer of patients from a community mental health team to general practitioner (GP) care or another appropriate team. Cut-off scores were calculated on the basis of previously published literature describing mean HoNOS scores of patients in GP and shared care settings.…”

Discharge Practices in a Time-Unlimited Intervention: The Perspectives of Practitioners in Assertive Community Treatment

“…Salyer et al (1998) identified criteria for moving clients to an ACT step-down team, including that the client had had no psychiatric hospitalizations for 1 year, was in stable housing, had no current substance abuse problems, and was rated by staff as functioning independently. Similar efforts to develop measures to inform discharge and transfer decisions in community mental health service system are underway in Australia (Prowse and Coombs 2009), where the focus is on measuring severity of problem behavior, impairment, symptoms, and social problems. Such tools need to include indicators in all bio-psycho-social aspects of the client, including, but not limited to, health, mental health, self care, social functioning, and social support, as well as measures for preventing relapse.…”

“…Moreover, practitioners' clinical judgment and clients' self-assessment ought to be reflected in this measurement process. Finally, the use of such tools should be limited to helping clinicians identify clients with good current potential for discharge, rather than to make discharge decisions (Prowse and Coombs 2009).…”