User-defined outcomes in mental health: A qualitative study and consensus development exercise

Abstract

Background: Client-centred care in mental health requires the collection of outcomes that are meaningful to both clinicians and to users of mental health services.

Aims: To elicit and prioritize mental health outcomes, from the point of view of service-users.

Methods: We conducted two service user focus groups exploring how service users understood the concept of outcome. Qualitative analysis identified a hierarchical “tree” of themes relating to outcome. We then used a Delphi Panel consensus method to prioritize these outcome domains.

Results: Forty-four individual outcome domains were identified. These were grouped into 6 categories of personal and social changes: Changes in Myself; Believing in Change; Satisfaction with Treatment; Managing Independently; Social Contact and Connection with Society. No particular pattern could be identified in the items that were most strongly endorsed in the Delphi exercise but two additional outcome domains were produced that had not appeared in the focus groups.

Conclusions: Although the domains of outcome identified in this study overlap with many of those that are commonly in use, there appeared to be a greater emphasis on non-clinical and social outcomes. Further research could explore these findings further and develop psychometrically robust instruments that more strongly reflect a user perspective.

Keywords:

• Mental health
• service users
• outcomes
• Delphi Panel
• Focus group

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Note

1. The Delphi Panel was originally developed by the RAND Corporation as a method of pooling the opinions of a diverse group of experts on a particular topic. The (often geographically dispersed) group are given a questionnaire designed to elicit individual responses to a particular problem or topic. They are then given information on the range and distribution of other panel members' responses and asked to reconsider their original response. The process continues over two or more “rounds” with the aim of moving participants towards consensus.