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

Figures & data

Figure 1. Diagrammatic representation of the three stages of concept elicitation, concept prioritisation and instrument development, including the number of participants in each stage.

Table 1. Final outcome framework from concept elicitation work.

About me

My life feels meaningful

I have a sense of belonging

My spiritual needs are met

I feel confident and have good self-esteem

I feel positive and hopeful

I feel enabled to make the changes I want to achieve my goals

I feel a sense of independence

My quality of life

My basic needs are met

My life has the structure I want and need

I have enough opportunity for enjoyable and meaningful activities

I have the relationships and friendships I want and need

I feel accepted by others and comfortable around them

My health

I am able to sleep well

I eat healthily

I am able to maintain a healthy weight

I have enough exercise

I can manage any unhealthy habits and behaviours

My mental and emotional health is currently good

I understand and manage my mental and emotional health well

I have helpful relationships with staff

I take any medication I need for my recovery

Any side effects from my medication are manageable

I am able to benefit from talking therapies

I am able to participate in planning my care

My safety and risk

I can recognise and cope with difficult feelings

I am able to manage difficult situations well

I am able to avoid behaviours and situations that reduce my safety

I understand and accept rules that enable everyone to remain safe

I feel safe

I am able to take responsibility for myself

I understand how my behaviour may affect others

I am able to recognise and respect the feelings of others

Others feel safe around me

My life skills

I am able to make realistic plans

I can make the decisions that I need to

I am able to trust others and ask for help when I need it

I am able to look after my everyday needs and those of people who depend on me

I have the skills, education and qualifications that I want

I am able to play a part in my community

My progress

I am at the right place for me in the mental health system

I am receiving and accepting the support I need from mental health services

I am making progress towards greater independence

Table 2. Participants in the Delphi process by stakeholder group.

	Round 1	Round 2
Professionals	38	28
Patients	20	18
Carers	4	3
Total	62	49

Table 3. Results of the Delphi process for patients and carers.

Round 2 rank	Outcome	Domain	Round 1 score	Round 1 rank	Round 2 score
1	I feel safe	My risk and safety	8.04	2	8.33
2	My basic needs are met	My quality of life	7.78	6	8.33
3	I am making progress towards greater independence	My progress	7.96	4	8.29
4	I am receiving and accepting the support I need from mental health services	My progress	8.09	1	8.19
5	I am able to trust others and ask for help when I need it	My life skills	7.92	5	8.05
6	I understand how my behaviour may affect others	My risk and safety	7.67	8	8.00
7	I am actively working on reducing my risk of harm to others	My risk and safety	N/A	N/A	8.00
8	I am able to participate in planning my care	My health	8.00	3	7.95
9	My mental and emotional health is currently good	My health	7.52	15	7.95
10	Others feel safe around me	My risk and safety	7.21	28	7.95
11	I am able to benefit from talking therapies	My health	7.57	12	7.90
12	I take any medication I need for my recovery	My health	7.77	7	7.90
13	I am able to sleep well	My health	7.57	11	7.86
14	I understand and manage my mental and emotional health well	My health	7.52	16	7.86
15	I understand and accept rules that enable everyone to remain safe	My risk and safety	7.25	26	7.86
16	I am able to recognise and respect the feelings of others	My risk and safety	7.17	29	7.86
17	My life feels meaningful	About me	7.65	9	7.81
18	I am able to avoid behaviours and situations that reduce my safety	My risk and safety	7.54	13	7.81
19	I feel confident and have good self-esteem	About me	7.52	14	7.81
20	I am at the right place for me in the mental health system	My progress	7.52	17	7.81
21	I am able to take responsibility for myself	My risk and safety	7.39	20	7.81
22	I can make the decisions that I need to	My life skills	7.48	18	7.76
23	I feel positive and hopeful	About me	7.61	10	7.71
24	I can recognise and cope with difficult feelings	My risk and safety	7.46	19	7.71
25	Any side effects from my medication are manageable	My health	7.32	22	7.70
26	I am able to look after my everyday needs and those of people who depend on me	My life skills	7.38	21	7.62
27	I have enough opportunity for enjoyable and meaningful activities	My quality of life	7.26	25	7.62
28	I have helpful relationships with staff	My health	7.00	37	7.57
29	I feel a sense of independence	About me	7.13	30	7.43
30	I have a sense of belonging	About me	7.30	23	7.38
31	I am able to play a part in my community	My life skills	7.29	24	7.38
32	I feel enabled make the changes I want to achieve my goals	About me	7.04	34	7.38
33	I can manage any unhealthy habits and behaviours	My health	6.91	39	7.38
34	I have the relationships and friendships I want and need	My quality of life	7.21	27	7.33
35	I am able to manage difficult situations well	My risk and safety	7.13	32	7.33
36	My life has the structure I want and need	My quality of life	7.04	35	7.24
37	I eat healthily	My health	7.13	31	7.19
38	I have enough exercise	My health	7.00	36	7.19
39	I am able to make realistic plans	My life skills	6.92	38	7.19
40	I feel accepted by others and comfortable around them	My quality of life	7.09	33	6.90
41	I have the skills, education and qualifications that I want	My life skills	6.83	40	6.90
42	I am able to maintain a healthy weight	My health	6.61	41	6.90
43	My spiritual needs are met	About me	6.26	42	6.19

Table 4. Results of the Delphi process for professionals.

Round 2 rank	Outcome	Domain	Round 1 score	Round 1 rank	Round 2 score
1	My basic needs are met	My quality of life	7.95	1	8.33
2	I feel safe	My risk and safety	7.81	2	8.19
3	Any side effects from my medication are manageable	My health	7.59	3	7.96
4	I take any medication I need for my recovery	My health	7.24	14	7.85
5	I am able to avoid behaviours and situations that reduce my safety	My risk and safety	7.49	4	7.77
6	My life feels meaningful	About me	7.46	6	7.74
7	I am receiving and accepting the support I need from mental health services	My progress	7.21	15	7.62
8	I can recognise and cope with difficult feelings	My risk and safety	7.46	5	7.54
9	I am able to manage difficult situations well	My risk and safety	7.43	7	7.46
10	I understand and accept rules that enable everyone to remain safe	My risk and safety	7.27	10	7.46
11	I am able to trust others and ask for help when I need it	My life skills	7.03	22	7.41
12	I am able to take responsibility for myself	My risk and safety	7.38	8	7.38
13	I have helpful relationships with staff	My health	7.30	9	7.38
14	I understand how my behaviour may affect others	My risk and safety	7.27	11	7.38
15	My mental and emotional health is currently good	My health	7.14	18	7.38
16	I am able to participate in planning my care	My health	7.03	21	7.35
17	I am actively working on reducing my risk of harm to others	My risk and safety	N/A	N/A	7.31
18	I understand and manage my mental and emotional health well	My health	7.14	17	7.27
19	I have the relationships and friendships I want and need	My quality of life	7.16	16	7.22
20	Others feel safe around me	My risk and safety	6.97	23	7.19
21	I feel positive and hopeful	About me	7.11	19	7.19
22	I have a sense of belonging	About me	7.24	12	7.15
23	I have enough opportunity for enjoyable and meaningful activities	My quality of life	7.24	13	7.11
24	I am making progress towards greater independence	My progress	6.67	29	7.08
25	I am able to benefit from talking therapies	My health	6.73	28	7.08
26	My life has the structure I want and need	My quality of life	7.11	20	7.00
27	I am able to recognise and respect the feelings of others	My risk and safety	6.84	25	7.00
28	I am able to sleep well	My health	6.89	24	6.81
29	I feel enabled make the changes I want to achieve my goals	About me	6.62	30	6.78
30	I am at the right place for me in the mental health system	My progress	6.78	27	6.77
31	I can make the decisions that I need to	My life skills	6.59	31	6.70
32	I am able to make realistic plans	My life skills	6.54	33	6.67
33	I am able to look after my everyday needs and those of people who depend on me	My life skills	6.51	34	6.67
34	I can manage any unhealthy habits and behaviours	My health	6.41	35	6.62
35	I feel a sense of independence	About me	6.41	36	6.44
36	I feel accepted by others and comfortable around them	My quality of life	6.84	26	6.41
37	I have enough exercise	My health	6.27	38	6.35
38	I feel confident and have good self-esteem	About me	6.57	32	6.33
39	I am able to maintain a healthy weight	My health	6.27	37	6.31
40	I am able to play a part in my community	My life skills	6.08	40	6.26
41	I have the skills, education and qualifications that I want	My life skills	6.27	39	5.93
42	I eat healthily	My health	5.97	41	5.93
43	My spiritual needs are met	About me	5.76	42	5.41