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Measuring recovery from serious mental ill-health - the HAO tool

People with lived experience of mental ill-health emphasise personal recovery as well as clinical outcomes, particularly the experience of hope, agency (a sense of control over our lives) and opportunity for purposeful activity and social inclusion, irrespective of mental health status. If we want to deliver recovery based mental health services, we need to measure recovery based outcomes.

The Hope, Agency and Opportunity (HAO) measure was developed jointly by researchers at the University of Southampton and the Southern Health Recovery College, alongside people with lived experience of mental ill-health. The HAO is a brief, validated measure of recovery that can be used with individuals, teams and services.


The measure can be used to assess individuals’ recovery, support collaborative care planning and evaluate services. The tool is freely available to clinicians, service leads and researchers, for any use that prioritises the principles and practice of recovery in our mental health services. The HAO is made available on the understanding that no modification is made to the copyrighted material. Any use other than for clinical, teaching or research purposes will require specific permission from us.


The HAO is available in the following formats:

The HAO can be used to start a conversation about recovery

  • Hear what people have to say about their hopes for the future, whether they feel in control of their lives, their opportunities to do what’s most important to them
  • Hear whether people's relationships with staff help or hinder their recovery
  • Talk together about how their recovery could be better supported

The HAO can be used to measure recovery outcomes

  • Assess the degree to which people experience a sense of hope, agency and opportunity for purposeful activity and social inclusion
  • Use this to develop collaborative recovery focused care plans
  • Monitor progress over time and following interventions

The HAO can be used for whole team self-assessment & service development

  • Seek direct feedback from the people who access your service
  • Get a picture of how recovery focused your team is, and where you could make improvements
  • Evaluate service development programmes

How to use the HAO

  • People can complete independently or be supported to complete the measure
  • Score each question from 0 (none of the time) to 4 (all of the time) and sum these for a total score
  • Add up Q1, Q2 and Q3 to give a ‘patient reported outcome measure’ (PROM)
  • Q4 gives a ‘patient reported experience measure’ (PREM)

Research Group
Centre for Innovation in Mental Health (CiMH)

We hope you will use the HAO to develop services in your area. Please let us know how you get on!


An introduction to the HAO Tool

This video briefly describes the purpose and development of the HAO.

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The HAO in Practice (Brief)

This brief video shows how the HAO can be used in clinical practice.

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The HAO in Practice (Full)

This longer video shows a full conversation based on the HAO.

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Key Publications

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