The measurement of improvement during hospitalisation for acute psychiatric illness

Objective: The aim of this paper is to compare clinical changes and lengths of stay of patients with schizophrenic and affective disorders in public and private hospital settings. Method: Recently published Australian work using the Health of the Nation Outcome Scales (HoNOS) was compared with new data collected in a public setting. Changes in HoNOS scores between admission and discharge were analysed against length of stay. Individual HoNOS items were also examined. Results: Public facilities tended to show greater improvements, owing to higher admission severities, and their lengths of stay tended to be shorter. Certain HoNOS items, notably the self-harm item, were significantly more severe in both diagnostic groups on admission in the public facilities. Conclusions: The findings are discussed in terms of the fact that self-harm is a criterion for involuntary hospitalisation, and private facilities do not treat involuntary patients. Certain problems assessed by the HoNOS are more amenable to rapid reduction than others, and this may contribute to differences in length of stay. Implications for outcome measurement are discussed.