SUMMARYAims– To clarify the acceptability, reliability and factorial validity of a new Italian version of the HoNOS called HoNOS-Rome. Its main innovations are both in design and in contents.Methods– Face validity was assessed by surveying 3 focus groups. Reliability was assessed in 8 different pairs of raters on a sample of 24 patients; construct validity was analysed by factor analysis using a sample of 187 patients at 6 day centres. Acceptability was investigated by means an anonymous questionnaire filled by professionals that were using the instrument.Results– Time of completion was low (range 4–12 minutes), the tool proved very acceptable and the reliability was good (weighted kappa ≥ 0.71 for all items). Factor analysis was consistent with the division of HoNOS–Rome into four sensible factors accounting for 52% of the total variance.Conclusions– The findings indicate that HoNOS–Rome has a satisfactory degree of acceptability, construct validity and reliability, and may promote the routine evaluation of outcomes in mental health services.Declaration of Interest: the authors declare that the study was supported by grant no. 96/Q/T41 of the Italian National Mental Health Project – Istituto Superiore di Sanità – Sub-project: Development and validation of tools for outcome evaluation of mental health services, Italy (Professor P. Morosini).