Table 5 Quantitative outcome measures

Disability

Self-rated and proxy-rated 12-item WHO Disability Assessment Schedule (WHODAS) 2.0

The 12-item WHODAS 2.0 is a generic instrument for assessing disability relating to any health condition across cultures. It has been used previously in South Africa for people with severe mental illness [24]. Item-response theory-based scoring will be used to convert scores to a 0–100 scale [36]. The WHODAS proxy version has the same properties as the self-rated version but has been designed to be answered by a caregiver, relative or friend [36].

Recovery

Recovery Assessment Scale- Domains and Stages (RAS-DS)

The RAS-DS is a self-report measure of mental health recovery [37]. It includes 38 items clustered into four domains of recovery: functional recovery (“Doing things I value”); personal recovery (“Looking forward”); clinical recovery (“Mastering my illness”); and social recovery (“Connecting and belonging”). Each item is rated on a 4-point scale from 1 = “untrue” to 4 = “completely true”.

“Percentage scores” are calculated for each domain and an overall score higher score represents more advanced levels of mental health recovery. It has been used previously in clinical settings in South Africa.

Unmet needs

Camberwell Assessment of Need – Short Appraisal Scale (CANSAS)

The CANSAS includes a list of 22 areas considered as potentially important needs for individuals living with mental illness. Each item is rated as either an “unmet need”; “met need” or “no need”. Percentage of unmet needs will be calculated based on number of unmet needs divided by total number of needs identified (unmet needs plus met needs). The scale has been previously used in South Africa [24].

Support for recovery

Brief INSPIRE

The brief INSPIRE assesses recovery support from a worker and has 5 items, each rated 0 “not at all” to 4 “very much”. Responses can be converted to a total score, ranging from 0 (low recovery support) to 100 (high recovery support) [41].

Internalised stigma

Internalized Stigma of Mental Illness (ISMI) Scale

The ISMI-R is a 29-item questionnaire assessing internalised stigma covering four subscales: “alienation”; “stereotype endorsement”; “perceived discrimination”; and “social withdrawal”. Items are scored on a 4-point Likert scale, from strongly disagree to strongly agree. Total scores are calculated by summing the items [38]. The scale has been previously used in South Africa [24].

Perception of respect and value

2 bespoke questions

Two questions “I feel valued and respected by my family” and “I feel valued and respected by my community” will be rated on a 4-point Likert scale, from strongly disagree to strongly agree.

Alcohol use

Alcohol use disorders identification test consumption (AUDIT-C)

The AUDIT-C includes three questions on alcohol consumption, each rated on a 0 to 4 scale. A total score can be calculated. It has been widely used and shown to be useful for assessing alcohol use in the South African context [39].

Health service use

Bespoke questions

Questions include number, duration and reason for inpatient admissions; and number of consultations with different types of healthcare worker in the last 2 months.

Relapse

Questions on police contact & hospitalization

Relapse is defined as either of:

• Inpatient admission for mental health of any duration (assessed as part of health service use)

• Any type of police contact related to mental health

Anti-psychotic Medication adherence

1 question

We will use a 5-point nominal scale measuring frequency of anti-psychotic medication adherence

Caregiver burden

Caregiving consequences section of Involvement Evaluation Questionnaire (IEQ)

31-item questionnaire assessing aspects of burden for caregivers of people with severe mental illness. All items are scored on 5-point Likert scales (0 never to 4 always). Domain scores can be computed (tension & urging range 0 to 36; worrying & supervision range 0 to 24)