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Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community

  • Martin Orrell (a1), Paula Yard (a2), Julia Handysides (a2) and Robert Schapira (a2)

The Health of the Nation Outcome Scales (HoNOS) have been developed for assessing the effectiveness of mental health services.


To investigate the validity and reliability of the HoNOS in patients in contact with mental health services.


Subjects (age range 19–64) came from day hospitals, acute in-patient units and out-patient clinics in general practice. We obtained the opinions of experienced professionals, advocacy groups and patient groups to evaluate consensual and content validity.


One hundred patients were assessed using the package of rating scales. Interrater and test–retest reliability were good for some items and poor for others. The HoNOS had good criterion validity: acute in-patients had higher scores than day patients and out-patients. HoNOS also had good concurrent validity, correlating well with other scales. Comments suggested that the HoNOS was a useful and suitable scale for this population but psychotic symptoms and certain social factors were not sufficiently covered.


The HoNOS had good validity but variable reliability. It may be better than existing scales because of the wide range of areas which it covers.

Corresponding author
Dr Martin Orrell, Reader in Psychiatry of Ageing, Department of Psychiatry and Behavioural Sciences. University College London Medical School, Wolfson Building, 48 Riding House Street, London WIN 8AA. Tel: 01279-827260; Fax: 01279-454018; e-mail:
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Declaration of interest

Funded by Hertfordshire Health Agency.

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Validity and reliability of the Health of the Nation Outcome Scales in psychiatric patients in the community

  • Martin Orrell (a1), Paula Yard (a2), Julia Handysides (a2) and Robert Schapira (a2)
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