wk 2 MH Flashcards
A minimum threshold must be met for someone’s experiences to meet the criteria for any given diagnosis, e.g.
- minimum no of symptoms
- Within a certain timeframe
- Symptoms typically require a change from functioning / an impact on daily life
What are the uses of psychiatric diagnoses?
For health services & clinicians
To facilitate clinical assessment (mainly psychiatrists; less so for clinical psychologists)
To aid communication (common language for all professionals)
To guide treatment decisions
To help organise mental health services
To facilitate research (in order to research something, we need to agree on how to define it)
What are the uses of psychiatric diagnoses?
For individuals who receive a diagnosis
Gives a name to difficulties
Allows individuals to look it up online
Offers meaning, understanding and explanation
Facilitates communication with and understanding from others
Provides access to care and support (e.g., benefits)
Helps find others with similar difficulties
How reliable is reliable enough? (Kraemer et al., 2012)
Now a ‘realistic goal’ is a kappa (IRR) between
Between ___ and ___ seen as acceptable
between 0.4 and 0.6
0.2 and 0.4
implications of diagnoses for the indiv
Language from the biomedical model (disorder, symptoms) means difficulties seen as problems within the individual
e.g:
- Pathologises ‘normal’ responses
- Contributes to power imbalance between clients & clinicians
- Perceptions of dangerousness & unpredictability
- Fear and desire for social distance (Read et al., 2006)
Consequences of focusing only on diagnostic symptoms
Focus is on symptoms not context
Therefore, for people with diagnoses that don’t come under this chapter, wider factors about their life may be missed.
As a result, people do not always receive support and treatment that addresses underlying issues
Around __% of those given the diagnosis of ‘borderline personality disorder’ are female
Clear evidence of a causal relationship between childhood trauma and later diagnosis of borderline personality disorder, particularly for ____trauma (Ball & Links, 2009)
Some researchers have therefore argued that instead of seeing women’s distress as symptoms of a ‘borderline personality disorder’ we should understand their difficulties as a response to …
75
sexual
societal sexual violence and oppression (e.g. Shaw & Proctor, 2005)
Embedded bias – Ethnicity and culture
Inequalities in MH diagnoses & MH care e.g.,Schizophrenia, Black African RR 5.72 (Halvorsrud et al., 2019)
e.g, you are ___ x more likely to be diagnosed with schizophrenia if you are black
6 x
The BPS Division of Clinical Psychology’s position statement (2013)
Criticises the value of psychiatric diagnosis, and calls for a paradigm shift - to new systems of understanding mental distress, that are not based on diagnosis or biomedical/disease models
- Limited clinical and research utility (due to poor reliability and validity)
- Limited cross-cultural applicability
- Encourages labelling, which increases stigma
- Diagnoses convey the idea that people’s difficulties can be understood in the same way as physical illnesses. Over-reliance on medication as the ‘answer’
- Little consideration of the context of people’s life story and social circumstances
- Exclude the possibility of finding meaning in people’s experiences, disempowering people, and preventing them from understanding how they might use their own resources to address their difficulties
Some possible solutions & alternative approaches
Develop more reliable categorical classification systems (unlikely to improve validity)
Organise services based on need & severity/complexity of distress
‘Complaint orientated’ approach - descriptions of experiences without implication of ‘a disorder’
Power Threat Meaning Framework (PTMF)published by BPS 2018
Trans-diagnostic approaches (more in later lectures)
Psychological formulation (more in later lectures)
