Threshold Assessment Grid (TAG)

What is the Threshold Assessment Grid (TAG)?

Citing TAG

Download TAG

TAG is distributed using an Attribution-NonCommercial-No Derivative Works 4.0 International Public Licence (CC BY-NC-ND 4.0), which means that it can be used without permission for clinical, educational or research purposes, providing no change is made to the content and no charge is made. You do not need to contact us for this permission.

If you wish to change the measure then you need to contact us to obtain our permission.

If you wish to charge for its use, either directly on a pay-per-use basis or indirectly by including it within a commercial product such as software or a book, then you will first need to contact us to obtain a commercial use licence granting an Attribution-No Derivative Works 4.0 International Public Licence (CC BY-ND 4.0).

The English version of TAG can be downloaded for free here

The English version of the TAG has three pages. The first page is the TAG measure. The second page contains an evidence-based checklist that helps identify some of the important aspects to consider when rating each domain. The third page contains further guidance and more details on rating the TAG.

Who can use the TAG?

The TAG can be used by anyone who needs to decide whether the severity of a person’s mental health problems warrants contact with mental health services. A wide range of professionals have successfully completed the TAG, including GPs, psychiatrists, psychiatric nurses, care managers, liaison mental health team staff, health visitors, parole officers, physicians, psychologists, housing officers, alcohol workers and voluntary sector workers. Training is not required, and it takes less than five minutes to complete the assessment.

How is the TAG scored?

TAG is scored by summing the scores for each domain:

None = 0
Mild = 1
Moderate = 2
Severe = 3
Very severe = 4

Summing the seven domain scores in this way gives the total score, which ranges from 0 to a maximum 24 (4 Severe, 3 Very severe).

So, for an assessment comprising three None, two Mild and two Severe domains, the total score would be 8 (1+1+3+3).

Development of TAG

TAG was developed between 1996 and 1998 by Mike Slade and colleagues at the Institute of Psychiatry (now the Institute of Psychiatry, Psychology & Neuroscience), King’s College London. The development process involved GPs, service users and carers, psychiatrists, psychologists, nurses, occupational therapists, care managers, housing workers and policy makers. Representatives from each of these groups took part in a series of consensus workshops (n=57). This led to the development of a draft questionnaire, which was then refined and finalised using a Delphi Consultation (n=58). The psychometric properties of the TAG were tested during 1999 and 2000, in a multi-site study involving 605 service users from 10 adult, elderly and day care mental health services throughout London. The use of TAG to improve access from primary care to secondary mental health services was investigated in a multi-site cluster randomised controlled trial. The study took place in 73 GP practices (408,839 patients) in London and Manchester from 2002 until 2005.

Sensitivity and specificity analysis found that a TAG score of 5 or more is a defensible approach to identifying people with severe mental health problems. This brief approach to screening is used as an inclusion criterion in many research studies.

Translating TAG

You have permission to translate the measure providing all these conditions are met:

a)The translation is clearly labelled both in English and in the translated language, e.g. TAG (Swedish).

b) The translation must be compatible with the original English measure. Minor modifications can be made to the anchor points for each item to maximise conceptual equivalence and ensure cultural compatibility, but other elements (7 domains, rating scale etc.) cannot be changed. We encourage but do not require the development of high-quality translations, for example by following a formal methodology for translation such as described here.

c) Your translation includes the following statement both in English and in the translated language:

TAG was developed in English by Mike Slade and colleagues at King’s College London. Further information available from researchintorecovery.com/tag. This translation was published in year by name and contact details (e.g. email address) of translator.

d) Your translation includes the following statement in English (and, where meaningful, in the translated language):

Distributed using Creative Commons License: CC BY-NC-ND 4.0.

This means that your translation is distributed using an Attribution-NonCommercial-No Derivative Works 4.0 International Public Licence (CC BY-NC-ND 4.0) so that it can be used without permission for clinical, educational or research purposes, providing no change is made to the content and no charge is made. Please contact us if you receive a request for permission to change or charge for your translation.

e) You send us a PDF copy of your translation which we will make available as a download in our translations list.

If you plan to make a translation please send us your name and email details to list in the translator table.

Download TAG Translations

TAG publications

The reference for the TAG is:

Slade M, Powell R, Rosen A, Strathdee G (2000) Threshold Assessment Grid (TAG): the development of a valid and brief scale to assess the severity of mental illness, Social Psychiatry and Psychiatric Epidemiology, 35, 78-85. Available here

The psychometric properties of the TAG were evaluated:

Slade M, Cahill S, Kelsey W, Powell R, Strathdee G (2002) Threshold 2: The reliability, validity and sensitivity to change of the Threshold Assessment Grid (TAG), Acta Psychiatrica Scandinavica, 106, 453-460. Available here

The feasibility of the TAG for routine use was evaluated:

Slade M, Cahill C, Kelsey W, Powell R, Strathdee G, Valiakalayil A (2001) Threshold 3: The feasibility of the Threshold Assessment Grid (TAG) for routine assessment of the severity of mental health problems, Social Psychiatry and Psychiatric Epidemiology, 36, 516-521. Available here

The screening criterion of a TAG score of 5 or more was empirically established:

Slade M, Cahill S, Kelsey W, Leese M, Powell R, Strathdee G (2003) Threshold 4: an evaluation of the Threshold Assessment Grid as an aid to mental health referrals, Primary Care Mental Health, 1, 45-54.

The use of this screening criterion was then tested in a cluster RCT involving 73 GP practices:

Slade M, Gask L, Leese M, McCrone P, Montaňa C, Powell R, Stewart M, Chew-Graham C (2008) Failure to improve appropriateness of referrals to adult community mental health services – lessons from a multi-site cluster-randomised controlled trial, Family Practice, 25, 181-190. Available here

A nested process evaluation explored the rhetoric and reality of the primary-secondary care interface:

Chew-Graham C, Slade M, Montaňa C, Stewart M, Gask L (2007) A qualitative study of referral to community mental health teams in the UK: exploring the rhetoric and the reality, BMC Health Services Research, 7, 117. Available here

TAG was compared with other standardised measures, and shown to be useful as a measure of global severity:

Salvi G, Leese M, Slade M (2005) Routine use of mental health outcome assessments: choosing the measure, British Journal of Psychiatry, 186, 146-152. Available here

TAG has been translated into a number of languages, and is now in use in international studies as a screening tool:

Puschner B, Becker T, Mayer B, Jordan H, Maj M, Fiorillo A, Égerházi A, Ivánka T, Munk-Jørgensen P, Krogsgaard Bording M, Rössler W, Kawohl W, Slade M, for the CEDAR study group (2016) Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR), Epidemiology and Psychiatric Sciences, 25, 69-79. Available here

Publications citing the TAG paper are listed here.