Translating ethical principles into outcome measures for mental health service research.
BACKGROUND
Mental health service research continues to use only outcome measures that are available rather than develop measures that are important. This paper argues that it is necessary to select and then define a set of ethical principles that can be operationalized and validated as outcome measures to provide a wider balance of information for health policy and clinical service decisions.


METHODS
The method used is to adopt a five stage procedure: (i) to select ethical principles most directly relevant for mental health services and their evaluation at the local level; (ii) to propose definitions of these principles; (iii) to validate these definitions; (iv) to translate the defined principles into operationalized outcome measures; and (v) to use these outcome measures in mental health services research, within the context of evidence-based medicine.


RESULTS
We address steps (i) and (ii) of this five-stage procedure. Nine principles are selected and defined: autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, coordination and efficiency. These principles can together be referred to as the three ACEs.


CONCLUSIONS
Of these nine principles, only two (effectiveness and efficiency) have so far been fully translated into quantitative outcome measures, upon which the evidence-based medicine approach depends. We propose that further concepts also be developed into a more complete multidimensional range of fully operationalized outcome measures.
Thornicroft
G
G
Section of Community Psychiatry (PRiSM), Institute of Psychiatry, London.
Tansella
M
M
D026686:Beneficence; D004992:Ethics, Medical; D019317:Evidence-Based Medicine; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007558:Italy; D008605:Mental Health Services; D028642:Persons with Psychiatric Disorders; D017063:Outcome Assessment, Health Care; D026684:Personal Autonomy; D040841:Resource Allocation; D012941:Social Responsibility