Development of the FORUM: a new patient and clinician reported outcome measure for forensic mental health services

ABSTRACT

Forensic mental health services provide care to people in secure psychiatric hospitals and via specialised community teams. Such services are typically low volume and high cost, often highly restrictive and average duration of inpatient care prior to discharge is long. Measuring outcomes of care is important to safeguard patients and the public, monitor progress, inform treatment plans and assist in service evaluation and planning. We describe the development in England of a new outcome measure for forensic mental health services. Patient interviews and multi-stakeholder focus groups were held to elicit key concepts. Thematic analysis was used to develop an outcomes framework. Fifteen patients participated in the interviews and 48 stakeholders in the focus groups. Six domains were identified in thematic analysis: ‘about me, my quality of life, my health, my safety and risk, my life skills and my progress’. Sixty-two stakeholders participated in the first round of the Delphi process, and 49 completed round two. Eight of the top fifteen outcomes were shared between patients/carers and professionals. Based on these results, a new outcome measure, the FORensic oUtcome Measure (FORUM), was developed including both a patient reported and clinician reported measure. Further assessment of the FORUM’s use to track patients’ progress over time, and facilitate shared decision-making and care planning, is required.

KEYWORDS:

• Outcomes
• PROM
• CROM
• forensic
• Delphi

Acknowledgements

We would like to thank the members of the Forensic Outcome Measures Patient and Public Advisory Group, including Alain Aldridge, Ian Callaghan, Sarah Markham and Chris Williams, and the two carers who supported this work, Anne Chan and Petra Tilly. We would also like to thank the Clinical Reference Group for Adult Secure Services, the Quality Network for Forensic Mental Health Services, the Recovery and Outcomes Network, Thames Valley and Wessex Forensic Network, Oxford Health NHS Foundation Trust and Nottinghamshire Healthcare NHS Foundation Trust for their support. Anybody wishing to use these measures should contact the copyright owners, the University of Oxford, via Dr. Howard Ryland, [email protected].

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Howard Ryland, Doctoral Research Fellow, DRF-2017-10-019, is funded by the National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care.