Measuring what matters in forensic mental health – with patients, not just about them

In forensic mental health services, clinicians have long measured patient outcomes. But they have done so alone. Patients – the people whose recovery is at stake – have had no structured way to report how they are doing or what matters to them.

The FORensic oUtcome Measure (FORUM) was developed to change that, giving patients and their clinical teams a shared tool to assess progress together – but the practical questions remained: who would complete it, when, and what would happen to the data.

Our approach and partners

Working with Oxford Health NHS Foundation Trust, Oxford University Innovation, and a Patient and Public Advisory Group, the team took a deliberately iterative approach. Rather than designing a rollout plan in advance and hoping it would stick, they started small and adapted at each stage.

First, they mapped the patient pathway through forensic services. Then they asked patients and clinicians directly: how should the FORUM be used, by whom, and when? They trialled it on a single ward, gathered feedback, evaluated what worked, and scaled to three wards. Only then did they move to digitise the measure – building it into Oxford Health's True Colours platform, where it now links directly to the electronic patient record system.

A Patient and Public Advisory Group shaped key decisions throughout, ensuring the tool reflected what mattered to the people it was designed to serve.

What we found – and why it matters

1. Patients and clinicians accepted and valued the FORUM. Interviews and focus groups confirmed that both groups found the measure feasible and meaningful – in services where collaborative outcome measurement had not previously been attempted.
2. Digital integration transformed the tool's usefulness. By embedding the FORUM within True Colours, scores are now collected digitally and displayed as graphs tracking change over time. Patients and clinicians can compare their ratings side by side. Item-level "heat maps" pinpoint specific areas where progress has stalled – making care planning conversations more focused and productive.
3. The FORUM went live on True Colours in September 2025 – linked to Oxford Health's electronic patient record system, Rio – and has been approved as the outcome measure of choice for the Trust's forensic services.
4. The FORUM is attracting national and international interest. Oxford University Innovation has issued 24 licences to date – to 20 NHS Trusts and four international organisations in Canada, Singapore, and Switzerland. Translation into Norwegian is underway.
5. The project built research capacity, involving a medical student, an MSc student, a higher trainee in forensic psychiatry, and two Trust research assistants – developing the next generation of researchers in implementation science.

What this means

For patients in forensic mental health services, the FORUM offers something that has been missing: a structured, routine opportunity to say how they are doing and to see that information shape their care. When a patient and their clinician sit down with a shared graph showing where their views align and where they diverge, the conversation changes. Care planning becomes genuinely collaborative rather than something done to patients.

At an organisational level, aggregated FORUM data could help services identify whether changes in practice are actually improving outcomes – replacing assumption with evidence.

What needs to happen next

Despite strong foundations, the FORUM is not yet in routine use at Oxford Health. A key manager who championed the project left the Trust, and the wider rollout of True Colours – which staff need training and login credentials to access – is still in progress. The immediate priority is to re-engage senior leaders in the forensic directorate and resolve these practical barriers.

Beyond Oxford, 20 NHS Trusts now hold licences, but adoption requires the same careful implementation work. National uptake will depend on whether services commit to the cultural shift the FORUM demands: treating patients as partners in measuring their own recovery.