A review and update of the Health of the Nation Outcome Scales (HoNOS).

Aims and method The Health of the Nation Outcome Scales (HoNOS) and its older adults' version (HoNOS 65+) have been used widely for 20 years, but their glossaries have not been revised to reflect clinicians' experiences or changes in service delivery. The Royal College of Psychiatrists convened an international advisory board, with UK, Australian and New Zealand expertise, to identify desirable amendments. The aim was to improve rater experience by removing ambiguity and inconsistency in the glossary rather than more radical revision. RESULTS: Changes proposed to the HoNOS are reported. HoNOS 65+ changes will be reported separately. Based on the views and experience of the countries involved, a series of amendments were identified. Clinical implications While effective clinician training remains critically important, these revisions aim to improve intra- and interrater reliability and improve validity. Next steps will depend on feedback from HoNOS users. Reliability and validity testing will depend on funding. Declaration of interest None.

A clinical psychologist in GP-Land: an evaluation of brief psychological interventions in primary care.

AIM: To evaluate the clinical outcomes and other impacts of brief therapy provided in a primary care setting by a clinical psychologist who was mainly employed in secondary mental health. METHOD: The outcomes of 23 primary care patients referred to a clinical psychologist were evaluated using the General Health Questionnaire (GHQ), the World Health Organisation Quality of Life (WHOQoL) scale, and the Beck Depression Inventory (BDI). A mixture of quantitative and qualitative data from patients and staff were analysed to identify other impacts of the intervention. RESULTS: Large improvements in BDI, GHQ, and WHOQOL scores were found, with strong changes consistent with the targets of the intervention. Patients reported primary-based clinical psychology input was more convenient and many engaged who had resisted referral to secondary mental health services. Other benefits to the service, including improved primary-secondary service integration, improved primary management of mental health difficulties, and improved liaison with mental health specialists, were reported by primary health staff. CONCLUSION: Brief psychological interventions by a visiting clinical psychologist in a general practice setting had substantial benefits for the patients and for the practice. This project indicates the value of integrated psychological input consistent with recent moves to better primary-secondary integration in mental health care.

Community solutions for the community's problem: an evaluation of three New Zealand community-based treatment programs for child sexual offenders.

The recidivism rate of 203 people mandated by the courts to attend three community-based child sexual offender treatment programs (175 treatment cases and 28 assessment-only cases) was assessed and compared with a probation comparison group. The recidivism rate was 8.1% for all participants treated in the community-based programs and 5.2% for participants who completed treatment. The recidivism rate for program attendees was approximately half that of those in the probation comparison group. The drop-out rate for treatment appears to be relatively high (45%) and noncompletion was associated with higher recidivism. These results indicate significantly better outcomes for offenders receiving specialized treatment and are consistent with, and toward the lower end of, recidivism rates reported in local and international evaluation studies.

Care coordinators: a controlled evaluation of an inpatient mental health service innovation.

The study aimed to evaluate the impact of introducing designated care coordinators into an acute mental health inpatient unit in terms of service delivery, clinical outcomes, and service user and significant other perceptions. A pre-post-controlled design was implemented with a consecutive sample of 292 service users admitted and staying more than 5 days in two wards, with care coordinators introduced in one ward. Data were obtained from clinical records, standard measures, and service user and significant other surveys. Care coordinator input was associated with significant improvements in service delivery and stronger involvement of significant others and community resources. Care-coordinated clients showed significantly better clinical outcomes, including the Health of Nations Outcome Scales behaviour subscale, less time in the intensive care subunit, less community crisis team input in the week following discharge, and lower rates of readmission in the month following discharge. Care-coordinated service users and their significant others gave higher ratings of service delivery, outcome, and satisfaction. The results indicate that designated care coordinators significantly improve care processes, outcomes, and service user experience in acute inpatient mental health settings.

Workforce Factors for Psychologists in CAMHS in New Zealand.

BACKGROUND: Recruitment and retention of psychologists for Child and Adolescent Mental Health Services (CAMHS) is difficult worldwide. This study: 1) identified factors that promote or hinder recruitment and retention of CAMHS psychologists; 2) explored training and its impact on CAMHS as a career choice; and 3) identified strategies to improve recruitment and retention of CAMHS psychologists in New Zealand. METHOD: Surveys were undertaken with four New Zealand groups: 1) all registered psychologists; 2) final-year professional psychology interns; 3) directors for professional psychology training programmes; and 4) psychology professional leaders in the public health system. RESULT: Psychologists with more pre-qualification training in CAMHS were more likely to work in CAMHS. Other psychologists reported they would have more likely worked in CAMHS if they had received more pre-qualification training. Factors that promote or hinder training, recruitment and retention are discussed. CONCLUSIONS: A range of practical strategies for improving recruitment and retention of psychologists to CAMHS were identified, including particular strategies for psychologists from minority cultures (particularly, Maori and Pacific Island psychologists). While undertaken in New Zealand, many of these findings are relevant internationally.

Walking apart but towards the same goal? The view and practices of Tongan traditional healers and western-trained Tongan mental health staff.

This study explored the mental health-related beliefs and practices of Tongan Traditional Healers and Tongan workers in the Western-style mental health services in Tonga. The groups showed very different explanatory models and treatment methods for mental health difficulties. A variety of methods, similar to those reported in other Pacific communities, were used by the Tongan Traditional Healers. The Traditional Healers had a negative view of the Western-style system, feeling it did not address the real issues in mental health that they considered more culturally and spiritually-based. Western-trained staff were generally more accepting of traditional healing, and incorporated aspects of Tongan culture into their practice, but did not typically include traditional healing practices. This study aimed to inform efforts to foster more synergy and collaboration between traditional and western healing approaches in Tonga and with Tongans elsewhere. The results may be relevant to other Pacific peoples.