May 2009

The best reason for emphasising outcomes

We collect outcomes under PRIMHD (programme for the integration of mental health data). Eventually the PRIMHD data should enable us to generate useful and interesting reports to feed back to services. This is good in that, up to now, clinicians collecting outcome data have received little if anything back. Not surprisingly clinicians question the point of collecting such information when it doesn’t seem to have any use.

As I have suggested in previous Information Pulse articles, the primary use of mental health information is about helping a service user to recover. In other words using outcomes can itself be seen as a therapeutic activity.

I had the good fortune recently to attend a workshop with Dr Scott Miller which helped to make the case for the primary use of mental health information brilliantly. Scott Miller is an internationally respected psychologist and researcher who has published widely on the issue of providing feedback to service users on their outcomes (The Heroic Client is his most well known book).

Scott Miller’s argument is that the fundamental reason service users engage with services is to relieve their distress. He has developed two short rating scales which measures service user distress – the outcome rating scale (ORS) and the session rating scale (SRS)- which are to be used prior to and after sessions with service users. These outcome tools are very short and simple to use. He emphasises that what is most important is the alliance which the clinician or therapist establishes with service users, not the model or theoretical orientation. Using the two tools contributes to a feedback link between the clinician/therapist and service user.

This is the way that the tools are integrated into clinical practice.

While HoNOS, HoNOSCA and HoNOS 65+ are clinician rated outcome measures, rather than self rated measures, they can ONLY have clinical utility if they are part of a feedback mechanism with service users. In order for this to occur service users - at the very least - need to know that this information is being collected and what it means for them.

There is a growing and impressive body of research now indicating the importance of feedback between service users and clinicians. This research indicates that when feedback over outcome results is present service user outcomes in general are improved.

As clinicians it is hard not to respond to this fact: feeding back outcome results to service users, improves their overall outcomes.

Anyone wanting to dip their toes into this research on feeding back outcome results to service users should look up the following:

• TalkingCure.com website where you will find information on the work of Scott Miller and the outcome tools mentioned earlier (including publications such as ‘The Heroic Client’)

I would also mention some of the work of Michael Lambert, arguably one of the first researchers to publish on the effects of providing outcomes feedback to service users. In particular I would recommend:

• Lambert M J et al (2001) the effects of providing therapists with feedback on patient progress during psychotherapy: are outcomes enhanced? Psychotherapy Research 11, 49-68
• Lambert M J et al (2005) providing feedback to psychotherapists on their patients progress: clinical results and practice suggestions Journal of Clinical Psychology 6, 165-174

Page last updated: 19 May 2009