Improving mental health outcomes assessment with the Mental Health Inventory-21

Objective: There is a growing consensus that mental health should be conceptualised as a complete state that considers both illness and well-being components. In Australian mental health services, the Mental Health Inventory (MHI) is the only one of the three currently used consumer outcome measures that includes this broader perspective. However, the MHI has been criticised for its length, and variable factor structure. In order to improve the clinical utility of the MHI, a reliability and validity study of the MHI was undertaken.

Method: The original 38-item version of the MHI was administered to an Australian adult community sample (n = 616), along with two other consumer outcome measures (BASIS-32 and Kessler-10), a measure of psychological distress (DASS-21) and a measure of well-being (Satisfaction with Life Scale).

Results: Parallel analysis did not support the original factor structure of the MHI. The data indicated a correlated three-factor structure, measuring psychological distress, emotional well-being, and hopelessness. Seventeen items were deleted due to split loadings > .3, producing a shorter 21-item scale. New simplified additive scoring rules were also developed to support the practical utility of the scale.

Conclusion: Research, clinical practice and consumer feedback consistently highlight the need for a balanced assessment approach to mental health, which considers not only illness symptomatology, but also the characteristics of well-being that support recovery. Use of the three subscales of the MHI-21 would support a complete state assessment of mental health outcomes.