Table 5 Analysis of the choice of outcome measures reported in the documents

1. What is the problem [of the choice of mental health outcome measures] represented to be?

• The need for mental health services to address individual deficits in functioning

2. What presuppositions or assumptions underpin this representation of the ‘problem’?

Biopsychosocial discourse:

• Mental ‘illness’ is situated within the individual (biologically, psychologically, and socially), represented by deficits as defined in the chosen outcome measures

• Quality mental health care addresses deficits in the individual

3. How has this representation of the ‘problem’ come about?

• Historical dominance of the biomedical model of mental illness within mental health disciplines

• Incorporation of the psychosocial into the biopsychosocial models in the 1970s

• Supported by neoliberalism as the main approach to mental health care governance

4. What is left unproblematic in this problem representation?

• Silencing of alternative approaches, e.g., strengths-based/recovery-focused services, clinician judgement

• The role of social determinants of health

5. What effects are produced by this representation of the ‘problem’?

• Stigmatising consumers by constituting people with mental health problems as having deficits that are measured and ‘fixed’ through mental health care

• Clinician burden to complete the measures, leading to prioritisation of clinician-rated measures and excluding consumer/carer perspectives

• Lack of focus on and funding for the broader issues affecting mental health

6a. How/where is this representation of the problem produced, disseminated, and defended?

Reports and publications; AMHOCN website and documents; items in the outcome measures; Diagnostic and Statistical Manual of Mental Disorders (DSM)

6b. How can it be questioned, disrupted, replaced?

• Use of strengths-based and recovery-focused measures

• Measure services rather than consumers

• Measure social determinants of health