Research on Social Work Practice, 24(1), 2014, pp.132-141.
Publisher:
Sage
This article examines problems in the clinical utility of the diagnosis of schizophrenia including reliance on questionable data, arbitrary criteria and categorization, inadequate precision for assessment and treatment evaluation, and omission of information on causal current and historical environmental factors. Some alternatives to the Diagnostic and Statistical Manual of Mental Disorders,
(Publisher abstract)
This article examines problems in the clinical utility of the diagnosis of schizophrenia including reliance on questionable data, arbitrary criteria and categorization, inadequate precision for assessment and treatment evaluation, and omission of information on causal current and historical environmental factors. Some alternatives to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) are briefly considered including continuous recording of individual client’s specific problems and goals, and functional assessments and functional analyses. The article discusses how biomedical assumptions implicit in the DSM-5 diverts mental health workers’ attention from social adversity factors contributing to the development of psychotic behavior and available psychosocial interventions for this disorder, thereby perpetuating biomedical dominance of mental health services.
(Publisher abstract)
Subject terms:
diagnosis, schizophrenia, mental health problems, medical model, mental health services;
Profiles an award winning memory service in Croydon. The service is run by the local NHS mental health foundation trust in partnership with Croydon's social services.
Profiles an award winning memory service in Croydon. The service is run by the local NHS mental health foundation trust in partnership with Croydon's social services.
Subject terms:
memory, mental health services, multidisciplinary services, dementia, diagnosis;
Journal of Mental Health, 17(6), December 2008, pp.618-628.
Publisher:
Taylor and Francis
Place of publication:
London
... for 15 - 24 year olds in Western and Northwestern regions of Melbourne, Australia. The study sought to identify differences between young people who were accepted into the service and those who were not with respect to psychiatric diagnosis, subthreshold symptoms, and psychosocial functioning. All young people aged 15 - 24 years who were referred to the service from April to September 2003 for assistance with non-psychotic disorders were approached for assessment. 204 individuals were referred to the service with non-psychotic problems over the data collection period, and 150 consented to participate in the study. Fifty nine percent of participants (n = 88) were accepted into the service (the RA group). They were more likely to have a current diagnosis than those not accepted into the service (the RNA group; n = 62). The RA group had higher levels of depression and anxiety, and lower psychosocial functioning, compared to the RNA group. The RNA group were also unwell: nearly 63% had at least one diagnosis at the time of referral. Both the RA and RNA groups showed functional impairment. Limited services are denying assistance to young people with significant morbidity and associated functional
Adolescents and young adults have a high incidence and prevalence of mental disorders, which can be disabling, chronic and lead to the development of further mental health problems. Yet their needs are not being adequately met by existing health structures. This study set out to examine the extent of met and unmet need in young people by assessing referrals to a public mental health service for 15 - 24 year olds in Western and Northwestern regions of Melbourne, Australia. The study sought to identify differences between young people who were accepted into the service and those who were not with respect to psychiatric diagnosis, subthreshold symptoms, and psychosocial functioning. All young people aged 15 - 24 years who were referred to the service from April to September 2003 for assistance with non-psychotic disorders were approached for assessment. 204 individuals were referred to the service with non-psychotic problems over the data collection period, and 150 consented to participate in the study. Fifty nine percent of participants (n = 88) were accepted into the service (the RA group). They were more likely to have a current diagnosis than those not accepted into the service (the RNA group; n = 62). The RA group had higher levels of depression and anxiety, and lower psychosocial functioning, compared to the RNA group. The RNA group were also unwell: nearly 63% had at least one diagnosis at the time of referral. Both the RA and RNA groups showed functional impairment. Limited services are denying assistance to young people with significant morbidity and associated functional impairment.
Subject terms:
mental health problems, mental health services, unmet need, young people, diagnosis;
Advances in Mental Health and Learning Disabilities, 1(2), June 2007, pp.45-47.
Publisher:
Emerald
Psychiatry in the United Kingdom has overhauled its approach to the provision of services for adults with autism spectrum disorders. This shift is set out in a new policy document, Psychiatric Services for Adults with Asperger's Syndrome and other Autistic Spectrum Disorders published by the Royal College of Psychiatrists. The author looks at what psychiatric services can offer.
Psychiatry in the United Kingdom has overhauled its approach to the provision of services for adults with autism spectrum disorders. This shift is set out in a new policy document, Psychiatric Services for Adults with Asperger's Syndrome and other Autistic Spectrum Disorders published by the Royal College of Psychiatrists. The author looks at what psychiatric services can offer.
Subject terms:
learning disabilities, mental health services, psychiatry, autistic spectrum conditions, diagnosis;
Disability and Society, 20(4), June 2005, pp.359-373.
Publisher:
Taylor and Francis
This paper presents findings from a study exploring the views of people with personality disorder diagnoses and various professionals working with them. The research was funded by Greater Glasgow Health Board Primary Care Trust and conducted by a team at the University of Stirling. After outlining the policy context and the study’s conceptual framework, the aims and methods are described. Interviews were conducted with 12 service providers and 10 users. The main findings are then discussed, including user and provider perspectives on the meaning of ‘personality disorder’ and the strategies and support people use to address their difficulties. Finally, the theoretical implications of the findings are discussed.
This paper presents findings from a study exploring the views of people with personality disorder diagnoses and various professionals working with them. The research was funded by Greater Glasgow Health Board Primary Care Trust and conducted by a team at the University of Stirling. After outlining the policy context and the study’s conceptual framework, the aims and methods are described. Interviews were conducted with 12 service providers and 10 users. The main findings are then discussed, including user and provider perspectives on the meaning of ‘personality disorder’ and the strategies and support people use to address their difficulties. Finally, the theoretical implications of the findings are discussed.
Subject terms:
mental health services, personality disorders, risk, user views, diagnosis;
Journal of Mental Health, 26(5), 2017, pp.395-404.
Publisher:
Taylor and Francis
Place of publication:
London
Background: There is limited research investigating how information about a mental health diagnosis is discussed and received.
Aims: To measure community-based service users’ satisfaction and preferences toward receiving news of a serious mental health diagnosis and to assess the acceptability of a diagnostic communication protocol (SPIKES: Setting; Perception; Invitation; Knowledge; Empathy; of diagnosis from additional health professionals rather than only a sole practitioner. The SPIKES protocol was rated as highly acceptable, with Empathy being rated as the most important feature.
Conclusions: This research indicates there were specific areas of communication practices which can be improved within mental health service provision, as a gap existed between participants’ desire for support
(Edited publisher abstract)
Background: There is limited research investigating how information about a mental health diagnosis is discussed and received.
Aims: To measure community-based service users’ satisfaction and preferences toward receiving news of a serious mental health diagnosis and to assess the acceptability of a diagnostic communication protocol (SPIKES: Setting; Perception; Invitation; Knowledge; Empathy; Summarizing).
Method: A survey was conducted with 101 participants.
Results: Participants rated the methods clinicians use to facilitate diagnostic discussions are highly important; however, they were not wholly satisfied with their experience. Higher satisfaction was reported if participants were provided with information in a face-to-face meeting, and if they received supplementary support at the time of diagnosis from additional health professionals rather than only a sole practitioner. The SPIKES protocol was rated as highly acceptable, with Empathy being rated as the most important feature.
Conclusions: This research indicates there were specific areas of communication practices which can be improved within mental health service provision, as a gap existed between participants’ desire for support and their experience. Strategies outlined in the SPIKES protocol, and others such as addressing stigma concerns, may prove useful in development of clinician training and service improvement.
(Edited publisher abstract)
Subject terms:
severe mental health problems, user views, stigma, diagnosis, communication, service users, mental health services;
British Journal of Psychiatry, 203(1), 2013, pp.58-64.
Publisher:
Cambridge University Press
Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed. This study documents the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). It also models the likely impact on efforts to reduce DUP of targeted changes in the care pathway. Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed. A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP. It is concluded that community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS.
(Edited publisher abstract)
Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed. This study documents the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). It also models the likely impact on efforts to reduce DUP of targeted changes in the care pathway. Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed. A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP. It is concluded that community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS.
(Edited publisher abstract)
Subject terms:
care pathways, early intervention, psychoses, mental health services, diagnosis, referral;
Children and Youth Services Review, 32(5), May 2010, pp.685-690.
Publisher:
Elsevier
Although high rates of mental health problems among children in foster care are well known, these problems are often not rapidly identified by primary care or other systems. This study, looking at a novel centralised delivery system and examining the identification of mental health within two paediatric medical homes for foster care, involved a retrospective medical review of all children (aged 6 to 18 years) entering foster care in two foster care clinics serving two county-wide populations. A sample of 242 children was used to describe demographics, rates for mental health problem identification, and length of time after entering foster care that mental health needs were identified. Using logistic regression analyses to examine variables associated with identification of mental health needs, it was found that both centralised foster care medical homes had high rates for identification of mental health problems (over 70% in both sites), timely identification within two months, and high mental health referral rates for children entering foster (over 70%)The findings suggest that attention to mental health needs for children in foster care within their primary care setting can impact identification rates and management of mental health.
Although high rates of mental health problems among children in foster care are well known, these problems are often not rapidly identified by primary care or other systems. This study, looking at a novel centralised delivery system and examining the identification of mental health within two paediatric medical homes for foster care, involved a retrospective medical review of all children (aged 6 to 18 years) entering foster care in two foster care clinics serving two county-wide populations. A sample of 242 children was used to describe demographics, rates for mental health problem identification, and length of time after entering foster care that mental health needs were identified. Using logistic regression analyses to examine variables associated with identification of mental health needs, it was found that both centralised foster care medical homes had high rates for identification of mental health problems (over 70% in both sites), timely identification within two months, and high mental health referral rates for children entering foster (over 70%)The findings suggest that attention to mental health needs for children in foster care within their primary care setting can impact identification rates and management of mental health.
Subject terms:
looked after children, mental health problems, mental health services, residential child care, child development, diagnosis;
Psychiatric Bulletin, 31(10), October 2007, pp.368-369.
Publisher:
Royal College of Psychiatrists
Providing better mental healthcare for the Black and minority ethnic population often requires much more than the efforts of the individual clinician. Problems may range from getting the right interpreters when they are needed, for as long as they are needed, to accessing psychotherapy and social service help for refugees and asylum seekers. Most of us have little training in negotiating differences in illness models, diagnostic labels and preferred pathways to care and treatment for a multicultural society All of these difficulties and more are reflected in the literature on disparities in care between ethnic groups in the UK. These problems are not the fault of clinicians but reflect the need for a concerted, coherent effort at an institutional level.
Providing better mental healthcare for the Black and minority ethnic population often requires much more than the efforts of the individual clinician. Problems may range from getting the right interpreters when they are needed, for as long as they are needed, to accessing psychotherapy and social service help for refugees and asylum seekers. Most of us have little training in negotiating differences in illness models, diagnostic labels and preferred pathways to care and treatment for a multicultural society All of these difficulties and more are reflected in the literature on disparities in care between ethnic groups in the UK. These problems are not the fault of clinicians but reflect the need for a concerted, coherent effort at an institutional level.
Subject terms:
mental health services, patients, racism, black and minority ethnic people, decision making, diagnosis, discrimination;
Psychiatric Bulletin, 31(10), October 2007, pp.365-366.
Publisher:
Royal College of Psychiatrists
There may be a minority of individuals in psychiatry who are racist, as there are in society as a whole. But much more vocal are those whose perception of reality is so distorted by examining all topics through the prism of racist thinking that they interpret all differences between ethnic groups in racist terms. Some have even gone so far as to advocate separate psychiatric services for individuals of different races, a proposal to our minds reminiscent of South Africa in the worst days of apartheid. No doubt they also interpret the high admission rates for alcoholism among Scottish and Irish males such as ourselves as evidence of English psychiatrists misdiagnosing the Scots and Irish because of their failure to understand the important symbolic role of drunkenness in Celtic culture.
There may be a minority of individuals in psychiatry who are racist, as there are in society as a whole. But much more vocal are those whose perception of reality is so distorted by examining all topics through the prism of racist thinking that they interpret all differences between ethnic groups in racist terms. Some have even gone so far as to advocate separate psychiatric services for individuals of different races, a proposal to our minds reminiscent of South Africa in the worst days of apartheid. No doubt they also interpret the high admission rates for alcoholism among Scottish and Irish males such as ourselves as evidence of English psychiatrists misdiagnosing the Scots and Irish because of their failure to understand the important symbolic role of drunkenness in Celtic culture.
Subject terms:
mental health services, patients, racism, black and minority ethnic people, decision making, diagnosis, discrimination;