The problem of patient-centred outcome measurement in psychiatry: why metrology hasn’t mattered and why it should

Abstract

Abstract. In psychiatry, there is a call for clinicians to use patient-centred outcome data routinely at the point of care to help tailor treatment plans to meet patient preferences and needs. Given that many decisions in psychiatry are constructed from patient narratives, it is critical that the conceptual, empirical, and measurement structure underlying patient reported outcome measures is robust and patient-centred. Here, we argue for the systematic accruement of patient-centred data in psychiatry to meaningfully enhance the treatment of mental disorders. Specifically, we suggest three crucial considerations for system transformation: (1) the engagement of international patient research partners to conceptualize and prioritize outcomes; (2) the application of modern test theory to develop and evaluate patient-centred outcome measures; and (3) funding allocation accountable to evidence-based services prioritized by patients.

“It cannot be boring!”: Developing a measure of function for young adults accessing integrated youth services

“…Ten (53%) reported living in a single room occupancy (SRO) hotel, group home, or Covenant House. SROs are a low-cost housing option in Vancouver typically made up of single rooms ranging from 8-12m 2 in size, including a sink, hot plate, and shared washroom facilities [ 4 , 5 ]. Four (21%) participants were living with someone else and six (32%) were living in an apartment.…”

“…However, as outlined in theories of emerging adulthood, what it means to function during this period of life may be distinct from that of adults. As well, what it means to measure for population epidemiological purposes, may be distinct from measuring the effectiveness of treatment over time for individuals [ 4 , 5 , 32 ]. As such, a PROM developed specifically for young adults in this unique stage of life is warranted [ 43 , 44 ].…”

“…Across Canada, service providers, organizations and decision-makers have struggled to understand what interventions are required for young people (including marginalized and racialized youth) to thrive and succeed [ 50 ]. This new item bank leverages existing work in youth engagement and measurement to understand health systems transformation for young Canadians [ 4 , 5 , 14 , 52 ]. In partnership with young people, our research highlights the importance of co-creating outcomes and measures that align with their needs.…”

“…Early learnings at Foundry highlight that ‘function’ is an important outcome for young people, their families, service providers, and funders [ 3 – 6 ]. Function, including physical, psychological, social, and occupational function, has been shown to have a significant association with health (mortality and morbidity) and social outcomes (i.e., social relationships, living circumstances, education and employment [ 4 , 5 , 7 , 8 ]. Youth and young adults with mental health challenges frequently face barriers to function, including barriers to education/employment, safe and affordable housing, and timely access to health services, [ 9 – 11 ].…”

“…Youth and young adults with mental health challenges frequently face barriers to function, including barriers to education/employment, safe and affordable housing, and timely access to health services, [ 9 – 11 ]. They also face barriers to communicating function to health providers, including a lack of youth-centred measures [ 4 , 5 ], lack of co-designed measures that are culturally relevant [ 12 ], and measures that create a common language for guiding care [ 13 ]. “Function”, as it is currently conceptualized and measured, is often associated with mental well-being and/or quality of life [ 14 – 20 ].…”