service-focussed view of the person. Their primary disadvantage is their invariance some – people get along very well in life without friends, or a partner, or a job. However, individual goals differ from person to person no standardized measure will have items such as – “swim with dolphins” or any of the other idiosyncratic goals individuals set and attain on their recovery journey. Any attempt to squeeze personal identity into predefined boxes can be justifiably criticized for its loss of meaning. This does not of course mean that personal goals should not be included in outcome evaluation they remain central, despite the difficulties in – assessing individual goal attainment. Rather, as McNamara (42) put it, challenge is to “The make the important measurable, not the measurable important”. So, an overall outcome evaluation strategy might measure two things. First, objective quality of life indicators, such as adequacy of housing, friendship, safety, employment and close relationships. Second, progress towards personal goals. Decision 6: Whose perspective? Assuming that the outcome for the patient is the main focus, the question remains of whose perspective is used. Two perspectives have primarily been used to evaluate outcome. First, and in our view most central, is the patient perspective. An emerging distinction in relation to patient-rated measures is between assessment oriented towards the experience of using mental health services and systems patient rated experience measures (PREMs) – – and assessment capturing direct health gain patient rated outcome measures (PROMs), – especially using patient-generated PROMs (PG-PROMs) (). A range of PROMs exist, spanning both clinical and recovery outcomes (). The development of PREMs is earlier stage, and has primarily focussed on satisfaction and experience of care. The main limitation of PREMs is that they may reduce the focus on a beyond illness”. People who use mental health “life services long-term can live in a institution”, in which key aspects of identity (social “virtual network, sense of self, housing, etc.) are all indexed on the mental illness (). PREMs such as satisfaction are a normative judgment influenced by the person’s reference group, so in people using mental health services positive ratings may be obtained because of an atypical reference group. This vulnerability of PREMs to being rated positively because of lowered expectations means that mental health systems should as far as possible evaluate success using outcome rather than experience measures.
service-focussed view of the person. Their primary disadvantage is their invariance – some people get along very well in life without friends, or a partner, or a job. However, individual goals differ from person to person – no standardized measure will have items such as “swim with dolphins” or any of the other idiosyncratic goals individuals set and attain on their recovery journey. Any attempt to squeeze personal identity into predefined boxes can be justifiably criticized for its loss of meaning. This does not of course mean that personal goals should not be included in outcome evaluation – they remain central, despite the difficulties in assessing individual goal attainment. Rather, as McNamara (42) put it, “The challenge is to make the important measurable, not the measurable important”. So, an overall outcome evaluation strategy might measure two things. First, objective quality of life indicators, such as adequacy of housing, friendship, safety, employment and close relationships. Second, progress towards personal goals. Decision 6: Whose perspective? Assuming that the outcome for the patient is the main focus, the question remains of whose perspective is used. Two perspectives have primarily been used to evaluate outcome. First, and in our view most central, is the patient perspective. An emerging distinction in relation to patient-rated measures is between assessment oriented towards the experience of using mental health services and systems – patient rated experience measures (PREMs) – and assessment capturing direct health gain – patient rated outcome measures (PROMs), especially using patient-generated PROMs (PG-PROMs) (). A range of PROMs exist, spanning both clinical and recovery outcomes (). The development of PREMs is earlier stage, and has primarily focussed on satisfaction and experience of care. The main limitation of PREMs is that they may reduce the focus on a “life beyond illness”. People who use mental health services long-term can live in a “virtual institution”, in which key aspects of identity (social network, sense of self, housing, etc.) are all indexed on the mental illness (). PREMs such as satisfaction are a normative judgment influenced by the person’s reference group, so in people using mental health services positive ratings may be obtained because of an atypical reference group. This vulnerability of PREMs to being rated positively because of lowered expectations means that mental health systems should as far as possible evaluate success using outcome rather than experience measures.
Thornicroft_Slade_Outcome_assessment.docx