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Revision of HoNOS and HoNOS65+

What does this mean for New Zealand clinicians?

This page provides a brief update on recent national and international research activities in the review of the HoNOS and HoNOS65+ tools.


In mental health services, clinicians use the HoNOS (Health of the Nation Outcomes Scales) to measure clinical symptoms and social functioning among adults (aged 18 to 64 years). The UK Royal College of Psychiatrists originally developed HoNOS in the mid-1990s. A modified version for older adults (aged 65 and over) was later developed and is known as HoNOS65+. Over the past two decades, both tools have demonstrated adequate measurement properties and clinical utility.

Revision of the tools

  • In 2018, the UK Royal College of Psychiatrists led a collaborative process with representatives from New Zealand and Australia to revise the HoNOS and HoNOS65+ tools.1,2 New Zealand experts were involved throughout this process to help ensure the future robustness and suitability of the tools for our local services.
  • The revised versions are respectively called HoNOS 2018 and HoNOS OA (older adults). While the structure of the tools has not changed, there have been changes to the overarching rating instructions and glossaries. These changes aim to remove ambiguity and minimise measurement error.
  • The UK has already adopted use of HoNOS 2018. New Zealand and Australia have not yet adopted the revised tools. New Zealand’s specialist adult mental health services continue to use the Ministry of Health mandated original HoNOS tool. The Ministry will inform the sector of any future decisions or changes around the use of HoNOS measures.

Review of HoNOS 2018 content validity

  • In 2020, a total of 32 HoNOS experts reviewed the content validity of the revised HoNOS 2018. This included nine New Zealand HoNOS experts who were mostly nurses and psychiatrists.
  • Overall, the findings show some support for the content validity of the HoNOS 2018. Expert ratings of the scales were mostly positively, though ratings varied in relation to each scales’ ability to capture change, comprehensiveness, and comprehensibility.
  • New Zealand experts rated all revised HoNOS 2018 scales as important for determining overall clinical severity.
  • A similar process has been undertaken to assess the content validity of the revised HoNOS OA for older adults.

Through a collaborative process, the Australian Mental Health Outcomes Classification Network (AMHOCN) analysed and reported the data collected in New Zealand, Australia and UK. Te Pou thanks the New Zealand HoNOS experts who participated in the review.

1 James, M., Painter, J., Buckingham, B., & Stewart, M.W. (2018). A review and update of the Health of the Nation Outcome Scales (HoNOS). BJPsych Bulletin. 42(2), 63-68.
James, M., Buckingham, B., Cheung, G., McKay, R., Painter, J., & Stewart, M.W. (2018). Review and update of the Health of the Nation Outcome Scales for Elderly People (HoNOS65+). BJPsych Bulletin. 42(6), 248-252.


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