The all-encompassing perspective of the mental health care patient.

Abstract

World Psychiatry 18:3 October 2019 adults, because it is the only measure of functioning that: a) has population norms and validation data across different countries; b) is well-understood both internationally and – through its inclusion in the DSM-5 – in the country that produces the most psychological treatment outcome data (i.e., the US); c) is already been used successfully in a range of major international studies; d) provides data that can be easily analyzed for cost-effectiveness studies, including possible conversion into population-level outcomes such as quality adjusted life years (QALYs), which is important for policy making; and e) is used in research across different areas of health, making improvements in its scores interpretable by an audience beyond mental health experts. Cuijpers also emphasizes the need to col lect data on the perspectives of those who are meant to be helped by the intervention, the so-called patients, clients, service users, consumers, or people with lived experience. Though WHO guidelines take the perspectives of these and other key stakeholders into consideration, so far the WHO GDGs have not listed person-defined outcomes as outcomes in PICO questions, likely because of the absence of a strong research tradition to collect such data. It is hoped that this may change in the future. Indeed, at the WHO we are promoting the use of person-defined outcomes through their routine inclusion in our own RCTs of psychological interventions among communities affected by adversity. Again, the consistent use of the same outcome measure will be important. At the WHO we currently use the Psychological Outcome Profiles (PSYCHLOPS) in many of our trials, and the experiences thus far are positive. Showing effects on a person-defined outcome measure is helpful to convince skeptics of etic approaches, who in some countries may include local policy makers, that a suggested psychological intervention is locally meaningful.