Measures of Mental Health Outcomes

While a review of treatment outcomes has been a consistent focus in the public mental health sector since the early 2000s there are few measures developed specifically for or studied with Aboriginal and Torres Strait Islander people.

Growth and Empowerment Measure (GEM)

The Growth and Empowerment Measure (GEM) was developed to measure psychological and social change in dimensions of empowerment as defined and described by Aboriginal Australians who participated in the Family Well Being programme. Empowerment is a complex process that requires both personal, organizational and structural change for Aboriginal individuals, families and groups to achieve positive growth and effectively address the social and psychological impacts of historical colonisation oppression, marginalization and disadvantage. Research to evaluate empowerment programs in community settings have demonstrated improvements in individual self-worth, resilience, problem solving abilities, health and interpersonal communication, with a subsequent reduction in interpersonal violence (Haswell et al. 2010).

The GEM is a 26-item self-report measure of emotional wellbeing and empowerment it has two components: a 14-item Emotional Empowerment Scale (EES14) and 12 Scenarios (12S). It is accompanied by the Kessler 6 Psychological Distress Scale (K6), supplemented by two questions assessing frequency of happy and angry feelings. It consists five domains: self-capacity, inner peace, strength, happiness and connectedness self-report measure of psychological and social empowerment. The measure was originally validated with 184 Aboriginal and Torres Strait Islander participants involved in personal and/or organisational social health activities.

Psychometric analyses of these instruments support their validity and reliability and indicate two-component structures for both the EES (Self-capacity; Inner peace) and the 12S (Healing and enabling growth, Connection and purpose). Strong correlations were observed across the scales and subscales. Participants who scored higher on the newly developed scales showed lower distress on the K6, particularly when the two additional questions were included. However, exploratory factor analyses demonstrated that GEM subscales are separable from the Kessler distress measure.

The GEM shows promise in enabling measurement and enhancing understanding of both process and outcome of psychological and social empowerment within Aboriginal and Torres Strait Islander contexts.

The measure is not part of the National Outcome Measurement set of measures.

Download the measure here.

Further reading

Berry, S. L., Crowe, T. P., Deane, F. P., Billingham, M., & Bhagerutty, Y. ( 2012). Growth and empowerment for Indigenous Australians in substance abuse treatment. International Journal of Mental Health and Addiction, 10, 970– 983. doi:10.1007/s11469‐012‐9393‐2

Haswell, M., Kavanagh, D., Tsey, K., Reilly, L., Cadet-James, Y., Laliberte, A., . . . Doran, C. (2010). Psychometric validation of the growth and empowerment measure (GEM) applied with Indigenous Australians. Australian and New Zealand Journal of Psychiatry, 44(9), 791-799.

Kinchin, I., Jacups, S., Tsey, K., & Lines, K. (2015). An empowerment intervention for indigenous communities: An outcome assessment. BMC Psychology, 3. DOI:10.1186/s40359-015-0086-z

Mental Health National Outcomes and Casemix Collection (NOCC)

The Mental Health National Outcomes and Casemix Collection (NOCC) involves regular assessment of mental health outcomes to measure if changes in consumers are a result of the mental health services they received.  All public mental health services are required to collect and submit this information. The assessment includes both clinician and consumer rated measures, with the aim that information derived from the measures will allow consumers and mental health workers to work together on the consumer’s recovery.  The Australian Mental Health Outcomes and Classification Network provides further information and links to all the measures included in NOCC The measures have not been adapted for or validated with Aboriginal and Torres Strait Islander people. Three measures have been studied with Aboriginal and Torres Strait Islander consumers of mainstream mental health services.

Health of the Nation Outcome Scales (HoNOS/HoNOSCA/HoNOS 65+)

These scales were specifically developed as a measure of severity of mental health disorder and to assess treatment outcome in people with mental illness.  The scales are completed by clinicians who rate  behaviour, impairment, symptoms and social functioning. There are separate versions for children, adults and adults over the age of 65 years.  A study by Trauer and Nagel (2012) explored clinical ratings for the HONOS in a sample of Aboriginal and Torres Strait Islander adults in Northern Queensland. The authors found support for use of the scale if consumers were engaged well and additional informants were involved in the assessment but questioned relying on clinical ratings alone.

Further Reading

Trauer, T., & Nagel, T. ( 2012). Outcome measurement in adult Indigenous mental health consumers. Advances in Mental Health, 11( 1), 106– 116