Outcome frameworks in Wales, Scotland and Northern Ireland

Scotland: outcome frameworks

There are 15 national outcomes across government that include increasing the average score on WEMWBS.
A very comprehensive and specific set of adult national mental health indicators has been developed in Scotland. It includes the following, (a summary document can be found here):

Mental wellbeing:

• Positive mental health national indicator: mean adult score on the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) from the Scottish Health Survey (SHS)
• Life satisfaction: mean adult score of how satisfied individuals are with their life as a whole nowadays from the SHS

Mental health problems:

• Common mental health problems: Percentage of adults who score 4 or more on the General Health Questionnaire-12 (GHQ-12) from the SHS
• Depression: percentage of adults who have a symptom score of 2 or more on the depression section of the Revised Clinical Interview Schedule (CIS-R) from the SHS
• Anxiety: percentage of adults who have a symptom score of 2 or more on the anxiety section of the Revised Clinical Interview Schedule (CIS-R) from the SHS
• Alcohol dependency: percentage of adults who score 2 or more on the CAGE questionnaire from the SHS
• Drug-related deaths: deaths per 100,000 adults in the past year from mental and behavioural disorders due to psychoactive substance use from General Register Office for Scotland
• Suicide: deaths per 100,000 adults in the past year by intentional self-harm and by undetermined intent from the General Register Office for Scotland
• Deliberate self-harm: percentage of adults who have deliberately harmed themselves but not with the intention of killing themselves in the past year from the SHS

This set also includes a comprehensive set of indicators of contextual constructs, risk and protective factors and their consequences at individual and community level. It also covers a set of structural indicators including income equality, social inclusion, discrimination, debt, financial security and the physical environment, together with working life indicators and indicators of violence.

Scotland has also produced a set of indicators of the mental health of Children and young people. These include:

Mental wellbeing:

• Mental wellbeing in children over 13
  • Mean score for 16 and 17 year olds on WEMWBS from the SHS
  • Mean score for S2 and S4 pupils on WEMWBS from the Scottish Schools Adolescent Lifestyle and Substance Use Survey(SALSUS)

• Life satisfaction: mean score of how satisfied 16 and 17 year olds are with their life as a whole nowadays from the SHS or Mean Score for P7,S2 and S4 pupils on adapted Cantril Ladder from the Health Behaviour in School Aged Children Survey (HBSC)
• Happiness: percentage of P7, S2 and S4 pupils who feel very happy with their life at present from the HBSC
• Pro-social behaviour from the SDQ: Percentage of S2 and S4 pupils with a .normal. score on the pro-social scale of the SDQ from SALSUS or
• Percentage of 4 to 12 year olds with a normal score on the pro-social scale of the SDQ from the SHS

Mental health problems:

• Common mental health problems: percentage of 16 to 19 year olds who score 4 or more on the General Health Questionnaire-12 (GHQ-12) (a score of 4 or more indicates a possible mental health problem over the past few weeks) from the SHS
• Emotional and behavioural problems:
  • Percentage of S2 and S4 pupils with a borderline or abnormal total difficulties score on the SDQ from SALSUS or
  • Percentage of 4 to 12 year olds with a .borderline. or .abnormal. total difficulties score on the SDQ from the SHS
• Emotional symptoms:
  • Percentage of S2 and S4 pupils with a .borderline. or .abnormal. score on the emotional symptoms scale of the SDQ from SALSUS or
  • Percentage of 4 to 12 year olds with a borderline or abnormal score on the emotional symptoms scale of the SDQ from the SHS

Conduct problems:

• Percentage of S2 and S4 pupils with a borderline. or abnormal. score on the conduct problems scale of the SDQ from SALSUS or
• Percentage of 4 to 12 year olds with a .borderline. or .abnormal. score on the conduct problems scale of the SDQ from the SHS

• Hyperactivity/inattention:
  • Percentage of S2 and S4 with a borderline or abnormal score on the hyperactivity/inattention scale of the SDQ from SALSUS or
  • Percentage of 4 to 12 year olds with a .borderline. or .abnormal. score on the hyperactivity/inattention scale of the SDQ from the SHS

• Sadness: percentage of P7, S2 and S4 pupils who felt sad quite often, very often or always in the last week from HBSC
• Alcohol dependency: percentage of 16 to 19 year olds who score 2 or more on the CAGE questionnaire (a score of 2 or more indicates possible alcohol dependency in the previous 3 months) from the SHS
• Drug-related disorders: hospital patients per 100,000 children and young people aged 19 years and under discharged in the past year for mental and behavioural disorders due to psychoactive substance use from ISD Scotland
• Suicide: deaths per 100,000 children and young people aged 19 years and under in the past year from intentional self-harm or by events of undetermined intent from National Records of Scotland
• Self-harm: incidence rate of intentional self-harm (self-poisoning or self-injury irrespective of the apparent purpose of the act, excludes self-harm through substance misuse, accidental self-harm and self-harm related to eating disorders) in the past year in children and young people aged 17 years and under (no suitable data source identified)
• Eating disorders: prevalence of eating disorders in children and young people aged 17 years and under (no suitable data source identified)

This data set also includes contextual constructs, risk and protective factors and consequences for children's mental health including:

• Individual learning and development, healthy living, general health, spirituality, emotional intelligence, life events
• Family: family relations, family structure, parental healthy living, parental health
• Learning environment: engagement with learning, peer and friend relationships, educational environment, pressures and expectations
• Community: participation, social networks, social support, trust, safety
• Structural: equality, social inclusion, discrimination, physical environment, violence, culture

Northern Ireland: outcome frameworks

The 10-year Investing for Health strategy has recently ended and is being reviewed with the purpose of developing a new outcomes-focussed public health strategy.

Wales: outcome frameworks

A new strategy Together for Mental Health was produced in 2012 with a proposal to measure a range of outcomes.

The strategy proposes legislative changes to provision in relation to:

• Expanding provision of primary mental health support
• Care co-ordination and plans
• Re-access to secondary care to previous service users
• Expanding independent mental health advocacy

References

1) McManus S et al. Meeting the mental health challenge in England: results from the Adult Psychiatric Morbidity Survey 2007, National Centre for Social Research, March 2009.
2) Tennant R, Hiller L, Fishwick R, Platt P, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcome 2007;5(63).
3) Clarke A, Friede T, Putz R, Ashdown J, Martin S, Blake A, Adi Y, Parkinson J, Flynn P, Platt S, Stewart-Brown S. Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Mixed methods assessment of validity and reliability in teenage school students in England and Scotland. BMC Health and Quality of Life Outcomes 2011;11:487.
4) Maheswaran H, Weich S, Powell J, Stewart-Brown S. Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS): Group and individual level analysis BMC Health and Quality of Life Outcomes 2012, 10:156.
5) Taggart F, Friede T, Weich S, Clarke A,Johnson M, Stewart-Brown S. Cross Cultural Evaluation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) A mixed methods study. Health and Quality of Life Outcomes.2013;11:27. DOI: 10.1186/1477-7525-11-27.
6) Stewart-Brown S, Tennant A ,Tennant R, Platt S, Parkinson J, Weich S. Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Biomed Central Health and Quality of Life Outcome 2009;7(15). ISSN 1477-7525.
7) Goldberg, D. P. & Williams, P. (1988). The User¡¯s Guide to the General Health Questionnaire. NFER-Nelson: Windsor.
8) Tennant R, Hiller L, Fishwick R, Platt P, Joseph S, Weich S, Parkinson J, Secker J, Stewart-Brown S. The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): development and UK validation. Health and Quality of Life Outcome 2007;5(63).
9) Clarke A, Friede T, Putz R, Ashdown J, Martin S, Blake A, Adi Y, Parkinson J, Flynn P, Platt S, Stewart-Brown S. Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Mixed methods assessment of validity and reliability in teenage school students in England and Scotland. BMC Health and Quality of Life Outcomes 2011;11:487.
10) Maheswaran H, Weich S, Powell J, Stewart-Brown S. Evaluating the responsiveness of the Warwick Edinburgh Mental Well-Being Scale (WEMWBS): Group and individual level analysis BMC Health and Quality of Life Outcomes 2012, 10:156.
11) Taggart F, Friede T, Weich S, Clarke A,Johnson M, Stewart-Brown S. Cross Cultural Evaluation of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) A mixed methods study. Health and Quality of Life Outcomes.2013;11:27. DOI: 10.1186/1477-7525-11-27.
12) Stewart-Brown S, Tennant A ,Tennant R, Platt S, Parkinson J, Weich S. Internal construct validity of the Warwick-Edinburgh Mental Well-being Scale (WEMWBS): a Rasch analysis using data from the Scottish Health Education Population Survey. Biomed Central Health and Quality of Life Outcome 2009;7(15). ISSN 1477-7525.
13) See www.sdqinfo.com