Background. Mental health service research continues to use only outcome measures that are
available rather than develop measures that are important. This paper argues that it is necessary
to select and then define a set of ethical principles that can be operationalized and validated as
outcome measures to provide a wider balance of information for health policy and clinical service
decisions.Methods. The method used is to adopt a five stage procedure: (i) to select ethical principles most
directly relevant for mental health services and their evaluation at the local level; (ii) to propose
definitions of these principles; (iii) to validate these definitions; (iv) to translate the defined
principles into operationalized outcome measures; and (v) to use these outcome measures in mental
health services research, within the context of evidence-based medicine.Results. We address steps (i) and (ii) of this five-stage procedure. Nine principles are selected and
defined: autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability,
coordination and efficiency. These principles can together be referred to as the three ACEs.Conclusions. Of these nine principles, only two (effectiveness and efficiency) have so far been fully
translated into quantitative outcome measures, upon which the evidence-based medicine approach
depends. We propose that further concepts also be developed into a more complete multi-
dimensional range of fully operationalized outcome measures.
Psychiatry in the future
