Tag Archives: psychiatry

The importance of a diagnosis?

Whilst you read this, please bear in mind that I am not a mental health professional. I am a service user who has been in the system for long enough to have been assigned an array of different diagnoses and labels in order to figure out what was wrong with me. Oh and these are literally just a collection of thoughts, with no real rhyme or reason to them…

I’m not “anti-diagnosis” by any stretch of the imagination. I really do believe that a diagnosis can be beneficial. By diagnosing someone accurately, you can then go onto providing appropriate treatment, whether that be therapy, medication, something else, or a mixture. There would be little use in incorrectly diagnosing someone, offering them an intervention which didn’t work, and then wondering why, 6 months later, little to no progress had been made. But how easy is it to accurately diagnose someone? In my experience, it seems to be quite hard. I have wandered for years through both inpatient and outpatient services, every so often being told that my diagnosis had changed, that the guys in charge had decided that I was no longer this or that. And I get it, diagnoses can change. You can ‘recover’ from something. But from what I can gather, the problem they faced was that my symptoms would overlap. Were my suicide attempts a result of depression? BPD? Of trauma? The intermittent nature of  the diagnoses I received led me to question the validity of them. How could someone outside of my head, not experiencing what I was, tell me what was wrong with me with any degree of certainty? It’s not a broken bone, you cannot just x-ray me to figure out what’s up. There was a point where I almost refused to acknowledge that diagnoses meant anything, however through my stubborn nature and my belief that a diagnosis didn’t exist, I ended up invalidating myself massively and getting increasingly frustrated as my distress was VERY real to me, but didn’t seem that way to others. I am however past that stage, and I do ‘believe in’ and see the use in a psychiatric diagnosis, although I do still have reservations about the potential transient nature of them!

There are a group of people who think that a diagnosis could do more harm than good. I suppose an obvious example would be the labeling theory: where the behaviour of an individual is said to be influenced by labels that are placed on them. Some would argue that mental health problems are a societal construct and people who are mentally ill are simply those who do not conform to the norms of society, resulting in the ‘mentally ill’ label. Once they have this label, they live up to the reputation and remain ill. I don’t agree with this, I think that it is a potentially damaging approach to take. A label can urge and encourage people to seek help. Most people who recognize that they are ill or hurt do get help – if I fell down the stairs and thought that I had hurt myself seriously I would probably go to A&E. If there I was told that I needed certain treatment, I would probably say yes! Unfortunately the opposite can be true of some who struggle with their mental health, a diagnosis can be incredibly stigmatizing and people may choose to suffer in silence rather than approach a professional or their family/friends. This is obviously damaging for the individual and a barrier to them seeking help.

On the whole, I do think that a diagnosis serves a purpose. Personally, I’m not sure how much importance I place on mine when I am given them, but I think that in the grand scheme of psychiatry they can be incredibly important.  They still seem to me quite telling of a professional’s preference (I’ve heard of some professionals who refuse to diagnose certain conditions, or those who diagnose most of their patients with the same diagnosis…) but they can be a useful tool in facilitating someone’s recovery.

Is the current state of crisis in the NHS a mirror of mental health services?

Ask anyone in Britain right now about the state of the NHS at the minute and they’ll tell you this: “it’s in crisis”. This fact is everywhere at the minute, and rightly so. The media reports and statistics are very much focused on physical health, a&e waiting times and the unavailability of GP appointments. Hospitals are declaring major incidents left right and centre as they struggle to cope with the demands on such underfunded services.

This is causing outrage – how can the NHS be struggling so much at the minute? It strikes me that this is a mirror image of what mental health services look like in many places, and have done for quite some time now. In 2013, whilst waiting for an inpatient (CAMHS) bed, I was told there were none in the country. None. I was later told that the closest bed was in Birmingham – I live in London. Thankfully a bed became available in London for me. I don’t recall the media having a field day over the fact that there were no beds in the entire country for young people. I was lucky, but some young people find themselves on adult wards, stuck in general hospital for prolonged periods of time, or even in police cells following a s135/136 where no alternative places of safety were accessible. Rarely do these instances make the headlines and even if they do, by no means do they dominate them with the same ferocity as we have seen recently.

Budgets in mental health services are consistently low. CAMHS only receives 6% of the total MH spending, of which £50m has been cut recently. How on earth are services meant to provide a well-rounded service with such little funding? Mental health problems present in adulthood are quite often prevalent in childhood/adolescence, so why does CAMHS get such a raw deal? Increased funding a resources put into CAMHS could change the face of AMHS – early intervention in youth could save lives and prevent problems from escalating. As I write this I am aware that this is well known, so I won’t waffle!

The reality is this: mental health services are in crisis. What seems to be an often overlooked crisis. Staff work incredibly hard and everyone I have come into contact with has been 100% dedicated to helping people. Despite being understaffed and over worked (as was so often apparent when I was an inpatient). Sometimes there’d only be one nurse on shift, co ordinating, bed managing, having to somehow look after the 11 people in their care, call the ETL to dispense meds whilst trying to find other young people a bed up and down the country. Not my idea of a relaxing Saturday morning! But despite that, everyone strives to do the best for those they are looking after. A nurse once said to me “if I could have you all on 1:1 to give you the nursing you all need, I would. But I can’t. ”

I digress. Just a small piece in recognition of all those who work in the NHS.