The use of the Health of the Nation Outcome Scale in an outreach rehabilitation program.

OBJECTIVE: The aim of this paper is to describe the use of the Health of the Nation Outcome Scale (HoNOS) in an outreach-based rehabilitation program in regional Victoria, Australia. METHOD: Routine outcome measures (ROM), including the HoNOS, were introduced in the Stepping Stones Recovery Program (SSRP) in 2002. HoNOS data routinely collected for 122 patients between 2003 and 2006 was examined for sensitivity in capturing clinical changes by using paired t-tests. RESULTS: There was a statistically significant decrease in total HoNOS scores as well as scores on subsets of 'impairment' and 'symptomatic problems'. HoNOS scores reflected positive changes in patients and were useful as a global overview, but did not tap into process issues that are more clinically meaningful. CONCLUSIONS: The SSRP provided a wide range of interventions and promoted a structured collaborative approach which could be the main reason for the uptake of ROM in this service. There are significant hurdles in integrating ROM in routine clinical practice, such as feasibility issues and clinician attitudes, along with larger systemic issues that need to be addressed. The introduction of ROM in Australia has resulted in strongly polarized viewpoints. Suggestions for facilitating the administration and use of ROM in routine clinical practice are discussed.

Self-reported confidence and skills of general practitioners in management of mental health disorders.

OBJECTIVE: To identify the predictors of self-reported confidence and skills of GPs in management of patients with mental health problems. DESIGN: Cross-sectional survey, with questionnaire presented to 246 GPs working in 62 practices throughout Gippsland. SETTING: Rural general practices in Gippsland. PARTICIPANTS: One hundred and thirty-four GPs across Gippsland. MAIN OUTCOME MEASURES: GPs completed a questionnaire assessing self-perception of knowledge and skills in recognition and management of common mental health problems. RESULTS: Of 134 GPs, 45% reported that they have a specific interest in mental health, and 39% of GPs reported that they had previous mental health training. Only 22% of GPs describe having both an interest and prior training in mental health care. Age and years since graduation are not significantly related to self-reported confidence and skills. CONCLUSIONS: The results of this study highlight that self-professed interest and prior training in mental health are associated. Self-professed interest in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health disorders. Similarly, prior training in mental health care predicts confidence and self-perceived skills in recognition, assessment and management of common mental health problems. Self-professed interest in mental health issues is also associated with hours of participation in continuing medical education related to mental health care. Unfortunately, only a minority described having both interest and prior training in mental health care.

A recovery-based outreach program in rural Victoria.

OBJECTIVE: A recovery-based outreach program for people with severe mental illness in regional Victoria is described. The paper covers a description of the program, the services provided and outcomes achieved. The program emphasized active collaboration between patients and clinicians as outlined in the collaborative recovery model and recognized that recovery from mental illness is an individual, personal process. CONCLUSIONS: The program provided service to 108 people over 3 years and had a positive impact on clinicians, patients and carers. The benefits of recovery orientation, multidisciplinary teams, collaborative relationships and carer involvement are discussed. The paper highlights the need for a focus on recovery and comprehensive care for people with severe mental illness.