This website is for people affected by mental illness, especially Te Mate Aronganui Pourua (Bipolar Disorder), their families, whanau, friends, support workers, doctors and nurses, and anyone else who cares about their recovery.

Who Knows HoNOS? 

 How do you know that your mental health is improving? Everyone has their own ways of deciding whether they are recovering or not. It may be that feeling less anxious, sleeping better, being able to go back to work, or not hearing voices are your particular indicators of health.

You may not be aware of this, but in New Zealand the ministry of health requires all district health board mental health services to rate your mental health with a questionnaire called HoNOS which stands for Health of the Nation Outcome Scale. The questionnaire is filled in when you start using a service, when you leave a service, and every three months in between.

There are twelve items in HoNOS and they are rated by a “clinician”. That means your psychiatrist, psychologist, nurse, social worker or occupational therapist. The aspects of your life given a score in HoNOS include such things as aggressive behaviour, suicide attempts, hallucinations and delusions, depressed mood, relationship problems and many more. Each item is given a rating from zero to four. Zero means there has been no problem with that aspect of your life over the last two weeks. A score of four means that in the clinician’s opinion there is a severe problem. This is a “clinical” tool. It is not done with you present but rather after the clinician has spoken to you. The ratings are strictly based on the clinician’s opinion and not necessarily on what you (the most important person in the process?) might believe or say.

So what are these numbers used for? Te Pou is funded by the ministry of health to promote HoNOS use in New Zealand. Te Pou’s website says that your mental health service will use your HoNOS scores “..to find out if their service is supporting your recovery.” This is simply not possible. There may well be a correlation between improving HoNOS scores and the quality of the service you are receiving. However, your improved mental health may also be due to many other things happening in your life which the doctor is not aware of. Statistical correlations prove nothing! For instance, children with larger ears are better at maths. That does not mean we need to provide extra tuition to kids with smaller ears. It just means that those children are on average younger and haven’t learnt so much maths yet.

Read more in the latest Enigma.

Fatal Crash Headline Stigmatising for people with bipolar

Thursday’s (4th February) Otago Daily Times article about a fatal eight car crash in Auckland was grossly stigmatising for people with mental illness. The headline read "Driver mental patient: Police". It was unnecessary and pointless to headline that the driver in the crash was a “mental patient”. The implication of the headline was clearly that the man’s mental illness had something to do with the crash. That seems to be sensationalist and uninformed speculation.

The article reported police as saying that the man was a “bipolar mental patient on medication”. Thousands of people have a diagnosis of bipolar disorder. They may include your shopkeeper, your lawyer or your school teacher. The article stigmatises those people when they are actually far more likely to be the victims of violence than the perpetrators. As the greatest risk factor for violence in our community is being male, a more useful headline may have been “Fatal crash driver was male”.

Read more in Enigma