Three outcome measures are listed on the website www.gpcare.org complete with the items and scoring method, the provenances and references. This site also contains a description of the new Commonwealth mental health initiatives, the WHO guides to the recognition and management of people with mental disorders seen in primary care [ICD-10-PHC], a description of the focused psychological strategies that are to be funded under the new scheme, and the three outcome measures discussed below.
Outcome measures are routinely used in medicine. For example, one wouldn't attempt to manage hypertension without a sphygmomanometer. Until recently comparable methods to measure health status have not been simple in people with mental disorders. To measure change in blood pressure due to treatment one has to measure twice at least. Measuring change or outcome in mental disorders is no different, one has to measure more than once, and the difference in scores is an indication of the change or outcome.
To be suitable as a routine measure of outcome, measures have to be brief, comprehensible, and easy to score. They should also be reliable, valid and sensitive to change. That is, they should return the same score when there is no change, measure what they claim to measure, and show change when there has been change. All three measures have been shown to be satisfactory in these regards.
SF12 [Medical Outcomes Study short form 12], a measure of disability (print measure) 
The SF12 is a 12 item, self-administered questionnaire that assesses symptoms, functioning and quality of life. It was developed from the Medical Outcomes Study, a 2 year observational study designed to understand how specific components of the general health care system in the US affected the outcomes of treatment. The 12 items take about five minutes for the patient to complete and the questions can be administered to people who can't read. The SF12 generates two scores; a mental component score and a physical component score. In a general population the mean score on each component is around 50, with scores of 40-49 indicating mild disability, scores of 30-39 indicating moderate disability and scores below 30 indicating severe disability. The response to each item is tagged with weights that are different for mental and physical components. These weights are added to a constant to give the final scores.
The value of the SF12 is that it can be used with patients with mental and physical disorders and so one can know how disabled a patient with depression is compared to a patient, say, with diabetes. The version of the scale printed here [click on the heading above] contains a brief integer scorer for the mental component scale suitable for primary care physicians. The MCS score is 61 plus the sum of the numbers corresponding to each item endorsed. As they mostly have negative values the sum of the scores will be a negative number that will need to be subtracted from 61. A score of 50 or greater indicates no disability, 40-49 mild disability, 30-39 moderate disability and less than 30 severe disability. In a population study the mean score is 50 and the standard deviation is 10, so a score of 25 will be 2.5 standard deviations below the mean. For a brief scorer for the physical component score see Andrews G. A brief integer scorer for the SF-12: validity of the brief scorer in Australian community and clinic settings. Australian and New Zealand Journal of Public Health, 26: 508-510, 2002.
K10 [Kessler psychological distress scale] a measure of current distress.
(print measure)
The K10 was developed by Kessler and others in 1992 as a screening scale for mental disorder and as a measure of non-specific psychological distress. It was used in the Australian Survey of Mental Health and Well-being (1997) and in the recent National Health Survey. The 10 items take about two minutes for the patient to complete and the questions can be administered to people who can't read. The K10 generates one score, of psychological distress, but this single score is a good proxy for whether the person is likely to have a mental disorder. The response to each item is given a weight [none of the time = 1, a little of the time = 2, some of the time = 3, most of the time = 4, all of the time = 5] that can be added up in less time than it takes to write a progress note.
Scores range from 10 to 50. People seen in primary care who score under 20 are likely to be well. People who score 20-24 are likely to have a mild mental disorder, people who score 25-29 a moderate mental disorder. People who score over 30 are likely to have a severe mental disorder. About 25% of people seen in primary care will score 20 and over. This is a screening instrument and clinicians should make a judgment as to whether a person needs treatment. Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered. The K10 is likely to become the industry standard.
Scores usually decline with effective treatment. Patients whose scores remain above 24 after treatment should be reviewed and specialist referral considered. For further information see Andrews and Slade, Aust NZ J Public Health, 2001; Kessler, Andrews et al, Psychol Medicine, 2002; Furukawa, Kessler et al, Psychol Medicine, 2002 .
HoNOS [Health of the Nation Outcome Scales], a measure of disability (print measure)
The HoNOS was developed by John Wing and others in 1994 for the UK specialist mental health services. It is a set of 12 rating scales to be completed by a trained health practitioner with ratings made on the basis of all available information and from routine assessment of the patient. There is a glossary and anchor point for each of the ratings within each scale. Practitioners will need special training to learn to use the scale reliably. The 12 scales cover aggressive or disruptive behaviour, suicidal thoughts and self-injurious behaviour, health or social problems associated with alcohol or drug use, problems involving memory orientation and understanding, problems associated with a mood disturbance, problems associated with hallucinations and delusions, other mental and behavioural problems (eg. panic, phobias, obsessions or compulsions, eating or sleeping disorders), problems in making supportive social relationships and problems in housing and locality, problems in employment, recreation and finance, overall severity of functional disability.
The HoNOS was intended for use with very sick patients. In primary care a doctor may decide, given the patient is unable to complete the K10 or SF12, to use one or two of the HoNOS scales to rate the salient behaviours. Rating one or two scales will be very quick and rating them again at a subsequent visit will show whether, in the doctor's judgement, the patient has improved or not. Few clinicians find it necessary to rate all the scales for they are specific to individual disorders.