Outcome frameworks in England

Public mental health outcomes in England are specifically related to both the public health strategy, Health Lives Healthy People, and the mental health strategy, No Health Without Mental Health.

The Public Health Outcomes Framework (PHOF) sets out many outcomes and indicators relevant to mental health as shown below. For detail of how each of these is measured, see the PHOF Summary Technical Specifications of Public Health Indicators.

Mental wellbeing:

  • Self-reported wellbeing, measured through four questions designed by the Office of National Statistics (ONS) and through the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) (1) (2) (3) (4) and the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) (5)
    - The percentage of respondents scoring 0-6 to the question "Overall, how satisfied are you with your life nowadays?"
    - The percentage of respondents scoring 0-6 to the question "Overall, to what extent do you feel the things you do in your life are worthwhile?"
    - The percentage of respondents who answered 0-6 to the question "Overall, how happy did you feel yesterday?"
    - The percentage of respondents scoring 4-10 to the question ¡°Overall, how anxious did you feel yesterday?
    - Average Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) score for adults (16+)
  • Emotional wellbeing of looked after children - total difficulties score from the Strengths and Difficulties Questionnaire (SDQ)13 for all looked after children aged between 4 and 16 (inclusive) at the date of their latest assessment, who have been in care for at least 12 months on 31 March

Mental illness:

  • Percentage of adults receiving secondary mental health services living independently at the time of their most recent assessment, formal review or other multi-disciplinary care planning meeting
  • Proportion of all people in prison who have a mental illness or a significant mental illness . indicator under development
  • Percentage of adults in contact with secondary mental health services in paid employment, compared to the percentage of all respondents to the Labour Force Survey classed as employed
  • Self-harm: the original definition based on hospital admissions was deemed insufficient and a further definition, possibly based on A&E attendances, is being explored
  • Excess mortality rate in adults with serious mental illness, ages under 75, per 100,000 population
  • Age-standardised mortality rate from suicide and injury of undetermined intent per 100,000 population
  • Dementia and its impacts. indicators under development.

The PHOF also seeks to monitor determinants of mental health, e.g.:

  • Percentage of children in relative poverty (living in households where income is less than 60 per cent of median household income before housing costs)
  • School readiness - percentage of children achieving 6 or more points across the 7 Scales of Personal, Social and Emotional Development (PSE) and Communication, Language and Literacy (CLL) and 78 or more points across all 13 scales.
  • Pupil absence rate - percentage of half days missed by pupils due to overall absence (including authorised and unauthorised absence)
  • Percentage of employees who had at least one day off sick in the previous week (TBC
  • Domestic abuse: under development
  • Statutory homelessness:
    - Homelessness acceptances (per thousand households)
    - Households in temporary accommodation (per thousand households)
  • Percentage of people using outdoor space for exercise/health reasons
  • Fuel poverty - under development
  • Social connectedness - under development, to be based on the responses to the question "Thinking about how much contact you.ve had with people you like, which of the following statements best describes your situation?"
  • Child development - under development
  • Physically active adults - proportion of adults achieving at least 150 minutes of physical activity per week in accordance with UK CMO recommended guidelines on physical activity
  • Heath-related quality of life for older people - under development, indicator will provide a greater focus on preventing ill health, preserving independence and promoting well-being in older people.

The determinants of mental health may also be the consequences of mental illness. Mental health problems are a potent cause of sickness absence, pupil absence, domestic abuse, homelessness, etc. It is important to monitor these but interpretation needs to take the bidirectional nature of the relationship between these determinants and outcomes into account.

The PHOF is supported by related outcomes within the NHS Outcomes Framework, the Adult Social Care Outcomes Framework and the Commissioning Outcomes Indicator Set.

A children and young people's health outcomes forum has also produced recommendations for monitoring child health.

A specific mental health dashboard (an easy to understand visual representation of key outcomes) is being developed by the Department of Health. This provides an outcome framework against the national strategy goals.

References

1) 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).
2) 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
3) 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.
4) 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.URL:
5) 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.

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