Beyond implementation barriers: toward epistemically reflexive patient-reported outcome measurement in mental health care

Patient-reported outcome measures (PROMs) are increasingly used in mental health care to support person-centred practice, clinical decision-making, service evaluation and quality improvement. However, patient-reported information is not necessarily patient-centred. PROMs redistribute the authority to report experience, but they do not automatically redistribute authority over what is measured, how responses are elicited and interpreted, or how resulting knowledge influences care. In this Perspective, we argue that persistent challenges in PROM implementation cannot be understood solely as technical problems of uptake, workflow or usability. They also concern how different forms of knowledge are produced, related and given authority within care. We introduce the concept of epistemically reflexive measurement practice and distinguish four domains of the measurement process in which epistemic authority is distributed: defining the measurement frame, defining personally relevant outcomes, eliciting patient-reported information, and interpreting and acting on PROM data. We argue that standardized and individualized approaches offer different but potentially complementary forms of knowledge, and that successful implementation requires attention not only to whether measures are completed, but also to the purposes they serve, the representational limits of measurement, and the role patient-reported knowledge acquires in clinical and organisational decision-making. Epistemically reflexive measurement may therefore strengthen the contribution of PROMs to genuinely person-centred mental health care.