Outcome Measurement in Psychiatry: a Critical Review. W. W. IsHak, T. Burt & L. I. Sederer (eds). Washington, American Psychiatric Association, 2002, £69.95 pb. ISBN: 0-88048-119-6

There is international interest in establishing outcome measurement as part of routine practice in mental health services. This book is therefore timely. Its main limitation is that it concentrates almost exclusively on developments in the United States. Only three of the 49 contributors have affiliations outside of the USA and only one outside of North America. Thus, the experience of those who are introducing routine measurement across entire national mental health care systems is not considered. This includes England, where the Department of Health is attempting to implement a common approach to the collection of outcome measures and performance indicators, and Australia where the Federal and State governments have already mandated routine outcome measurement for all public and private mental health care providers, using a common, core set of measures. These developments in Australia refute the book’s somewhat parochial contention that ‘a national system of outcomes management… remains more tomorrow’s technology than today’s’.

Having said this, this 450-page book is a useful reference source, both about the opportunities and challenge of introducing routine measurement and about the psychometric properties of some of the measures themselves although here, once again, the focus is almost exclusively on instruments developed in the USA. Separate chapters discuss outcome measurement in the different psychiatric specialities and for the main classes of disorder. However, as might be expected from a book with so many contributing authors, the chapters vary in quality and in depth. The chapter about outcome measurement in mood disorders stands out for its critical reviews of specific measures, which include tidy summaries of reliability, validity and sensitivity.

The final section of the book considers the practicalities of implementation, with some informative case studies of attempts to introduce routine outcome measurement in local mental health care systems. These sound a note of caution to those wishing to do this, that is relevant whether the attempt is within a single team or across an entire country. The lessons are summarised neatly with the conclusion that “the introduction of an outcome measurement program into a system of care is a delicate management process… if unsuccessful, the program can get mired in expensive and mindless data collection. It can alienate overburdened clinicians and support personnel”.