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November 3, 2019 by University of Liverpool

Psychiatric diagnoses ‘neither necessary nor sufficient’ for access to NHS care

A new study, published in the Journal of Mental Health, finds psychiatric diagnoses are seldom used as entry criteria for NHS mental health services.

Despite controversy over their validity, and the damage they can do to people who receive the labels, psychiatric diagnoses are usually argued to be essential for accessing care, determining treatment options, communicating between mental health professionals, and planning services.

However, a new study conducted by researchers from the University of Liverpool, has found, contrary to expectations, that psychiatric diagnoses are seldom used as entry criteria for NHS mental health services.

The study involved Freedom of Information requests made to 17 NHS adult mental health Trusts, asking for the entry criteria for their services.

Results

The research revealed that diagnoses were neither necessary nor sufficient in service entry criteria. Broad clusters of difficulties were used rather than specific diagnoses (except when diagnoses were used, contrary to NHS recommendations, as exclusion criteria).

The researchers found that while psychiatric diagnoses are commonly thought of as ‘essential’, in fact most NHS services did not use diagnoses as inclusion criteria. Instead, most services accepted referrals on the basis of need and the specialist skills of their staff.

The authors conclude that diagnostic labels in mental health are not, as is commonly assumed, necessary for NHS service access. Psychiatric diagnosis may be more of a historical artefact than a necessity for service entry. This opens the way for alternative – more scientifically valid and less stigmatising – ways to meet the practical requirements of modern mental health services and address people’s needs.

Good news

Lead researcher Dr Kate Allsopp, said: “Psychiatric diagnoses are controversial – defended strongly by many psychiatrists and psychologists but also criticised as scientifically invalid and pathologizing. One reason that psychiatric diagnoses survive, despite the criticisms, is that they are usually thought of as essential tools for accessing mental health services.

“Our research clearly shows that access to NHS services rarely depends on diagnosis, but instead on need. This is good news, because it means that there is no barrier to developing better, more humane, services.”

Professor Peter Kinderman, said: ”This study shatters a myth about psychiatric diagnosis that has blocked progress for decades. Although we have always been aware of the limitations of biomedical psychiatric diagnosis, we have also always been told that diagnoses are vital tools in determining access to services.

“In fact, as this research makes clear, the diagnostic approach in psychiatry is almost irrelevant to service access – despite what we have been told, most NHS services, quite rightly, welcome people who could benefit from them, rather than people who meet some artificial diagnostic criteria. There’s no reason, therefore, not to do things better.”

The full study, entitled ‘The use of diagnoses in mental health service eligibility and exclusion criteria’, can be found here.

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