Academic journal article Australian Health Review

It's Not That Bad: The Views of Consumers and Carers about Routine Outcome Measurement in Mental Health

Academic journal article Australian Health Review

It's Not That Bad: The Views of Consumers and Carers about Routine Outcome Measurement in Mental Health

Article excerpt


The mandatory use of routine outcome measurement (ROM) has been introduced into all public sector mental health services in Australia over the past 6 years. Qualitative processes were used to engage consumers and carers in suggesting how the measures can be used in clinical practice. The project involved an audit by survey, followed by a range of interactive workshops designed to elicit the views of consumers, carers and clinicians, as well as to involve all parties in dialogue about ROM. In addition, there was engagement of consumers and carers in the training of clinicians in the clinical use of ROM, and in the production of promotional materials aimed at informing consumers and carers about ROM. When consumers and carers have had an opportunity to be involved in ROM they have found it a useful experience, and those who had not been involved can see the potential. Consumers and carers indicated that they believe the greatest opportunity arising from the suite of measures is the use of the consumer self-assessment measure the Behaviour and Symptom Identification Scale (BASIS-32).

Aust Health Rev 2009: 33(1): 93-99

ROUTINE OUTCOME MEASUREMENT (ROM) has been introduced into all states and territories in Australia as part of the National Mental Health Strategy.1 Under the National Outcomes and Casemix Collection a suite of standard measures has been introduced as well as a protocol for their use.2 These have included clinician-rated measures such as the Health of the Nation Outcome Scales (HoNOS)3 and the Life Skills Profile (LSP),4 as well as consumer self-report measures such as the Behaviour and Symptom Identification Scale (BASIS-32).5 A standard data collection protocol means that clinicians complete relevant clinician-rated measures at regular intervals and are required to offer the selfassessment to consumers being cared for in the community at entry to the service, at review every three months while the consumer continues to receive the service, and at discharge from the service setting.

Trauer et al identified a range of concerns that clinicians express in relation to ROM, including barriers presented by information technology, the instruments themselves, the time burden, suspicion of management and government, and competence and confidence in using the resulting data.6 Lakeman has argued ROM does not add meaningful information to clinical practice. He suggests that nurses, in particular, are being asked to engage in a process that many service users find oppressive and which is ethically questionable. He suggests that it is the quality of the relationship between clinician and consumer that makes the difference.7 Callaly et al found that given 2 years' experience using the measures, clinicians value the consumer self-report measure as a way of developing the relationship with the consumer, improving dialogue and supporting care planning. They also suggest that an ability to do this requires commitment and resources from management. Further, they found that all observations offered by clinicians as to whether the consumer-rated measure was clinically of value reflected a positive attitude to its clinical use.8

Although the attitudes and concerns of clinicians with regard to ROM have been well documented, the views of consumers and carers are less well known. Graham et al found that consumers support the introduction of ROM and see it as having potential to contribute to the treatment they receive. However, they expressed reservations around the suitability of the BASIS-32 to meet their needs and the capacity of mental health services to engage in "good processes" in relation to using the consumer self-report measures.9

More recently, in a consumer-led study of the attitudes of 40 consumers who were offered the BASIS-32, Guthrie et al found that consumers see the benefit of routine outcome measurement and believe it leads to improved care.10

The project

In 2004 the Victorian Department of Human Services (DHS) set up the Quality Through Outcomes Network (QUATRO) to consolidate the routine use of outcome measurement data in public mental health services. …

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