Diagnosis - Mental Health Problems

This is a great parody booth of the "Peanuts" Lucy character at a festival, but it is surprising how many people on the Internet are dispensing mental health and medical advice without a license.
This is a great parody booth of the "Peanuts" Lucy character at a festival, but it is surprising how many people on the Internet are dispensing mental health and medical advice without a license. | Source

How To Obtain a Correct Mental Health Diagnosis

Writing about certain aspects of psychological and psychiatric diagnosis, I am reminded of the practice of school systems in my locale permitting teachers with bachelor's degrees in education to diagnose Attention Deficit and Attention Deficit Hyperactivity Disorders for a decade or fifteen years. They were also permitted to change dosages of related medications prescribed for these youngsters in grade K-5.

The problem for that fifteen years is that by state law, these teachers practiced psychiatry and psychology without a license. Further, many of their diagnoses were incorrect. In addition, they went beyond medication adjustment and precribed adjuncts such as "no physical activity, physical education, or sports", "no recess", and "no breaks." Many children's behaviors became worse rather than better, and their report cards showed declining grades. More children began attending summer school in order to retake classes.

Physicians and mental health specialists attending these children handled by the teachers mentioned above were incredulous. Many of these professionals complained to various authorities. The families of these students were caught in what seemed like a war.

In the end, it cannot be overstated that a mental health diagnosis needs to be made by a properly trained and licensed or certified individual that has a proven track record of competence in mental health diagnosis and treatment.

Diagnosis Requires Investigation

Sherlock Holmes uses the couch for thinking rather than psychiatry in "The Blue Carbuncle", with Dr. Watson. The hat is a clue, just as in a mental health case, many small and large clues can be found in a proper assessment.
Sherlock Holmes uses the couch for thinking rather than psychiatry in "The Blue Carbuncle", with Dr. Watson. The hat is a clue, just as in a mental health case, many small and large clues can be found in a proper assessment. | Source

The Full Diagnosis - Leaving No Stone Unturned

Another quality of a good mental health diagnostician and therapist is the ability and willingness to work with the patient or client and the family in order to reach the best result.

Families and patients often have important input that can help the professionals on the case and this seems especially true for ADD/ADHD and Autism Spectrum Disorders (ASD); the recognition and treatment or management of both of which have been steadily and consistently advanced by caring parents.

At the same time, the experienced mental health professional will recognize cases in which some family member wants to label their patient with a diagnosis that is not at all correct. The resons for this must be sorted, but families and patients must work with the professional and allow the therapist to be the therapist. If a family feels that their child has been misdiagnosed, then a second opinion should be welcomed by all involved. Soemtimes, we need to change mental health providers.

Professional Assessment and Counseling Eligibility

The above link leads to a thorough explanation of the process toward reaching a mental health diagnosis, based on a complete assessment that takes several steps. Further, only certain trained professionals may legally perform a mental health assessment, based on state licensing and oversight boards.

In Ohio, those that may perform mental health assessments, mental heath treatments, and even hypnosis are limited to:

  • Psychiatrists - MDs and DOs; also, any MD and any DO (all of these are eligible to prescribe medications; psychologists are not trained or permitted to do so).
  • Psychologists - PhDs and PsyDs; and Licensed School Psychologists
  • Psychology Assistants, Aides, Fellows, Interns, Residents, Postdocs, and Trainees under required Supervision
  • Licensed or Certified Counselors and Counselor Trainees
  • Marriage and Family Therapists
  • Physician Assistants (permitted to do assessments; are not permitted to do counseling/therapy)
  • Registered Nurses, Nurse Practitioners, Clinical Nurses; also, any MSN
  • Social Workers and Trainees

Chek out your own state laws that govern Mental Health Services under your state's Department of Mental Health.

ALERT I

Previous to the diagnostic mental health manual known as DSM-V (officially takes effect in May 2013) for America, previous versions required diagnoses to be placed onto clearly defined Axes I, II, III, IV, and V, each Axis declaring a certain classification of conditions and/or R/O, the Rule Outs. Rule Outs, oversimplified, are conditions that have some or many of the features of the diagnosed condition and bear mentioning.

In DSM-V, there are no Axes:

DSM-5 will move to a nonaxial documentation of diagnosis, combining the former Axes I, II, and III, with separate notations for psychosocial and contextual factors (formerly Axis IV) and disability (formerly Axis V).- American Psychology Association

In DSM-V, Autism is handled differently:

“Autism criteria will incorporate several diagnoses from DSM-IV including autistic disorder, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder (not otherwise specified) into the diagnosis of autism spectrum disorder for DSM-5 to help more accurately and consistently diagnose children with autism,” - APA

For additional disorders added in 2013 and for other changes, see HERE.

It is important that after May 2013, that mental health professionals use the DSM-V and eliminate older editions of the diagnostic manual. They will be incorrect and will lead to insurance coverge problems stemming from incorrect/outdated diagnoses and condition names, and other issues. More about DSM changes:

There is one on every corner these days.
There is one on every corner these days. | Source
The World According to Lucy
The World According to Lucy

For entertainment purposes only :)

 

ALERT II

Readers can see a variety of articles about mental health diagnosis on the Internet and some are useful,written by doctors, nurses, counselors, social workers, professional scientific writers, and similar eligible people. Other articles are written by individuals experiencing mental health conditions and offer their insights into their conditions and treatment - these can be quite enlightening.

Another segment of articles on mental health diagnosis are harmful in their misinformation and in their authorship by untrained/uncertified persons that do not understand or perform diagnoses professionally. Some of these contributors see a few - or even many - symptoms of a disorder they have read or heard about and immediately label someone else with that malady. They do not realize that many conditions overlap and can mimic one another, that physical illnesses can look like mental health problems and visa versa, and that it requires specialized training in order to make a correct diagnosis. Even then, sometimes a diagnosis is incorrect.

We readers can be discerning and realize that for writers untrained and unlicensed in mental health professions, perhaps using outdated versions of the DSM and not realizing a new edition was published, and/or copying and pasting a whole entry on a mental health condition(s) from the copyrighted manual or the APA website, and/or suggesting that a third party has "_______" condition is at best unethical and copyright violations are illegal.

If these writers suspect a friend or associate has a certain condition, they may be correct to some extent and they can make a suggestion to that person (or the family in case of a child) to see a professional; if a person becomes violent and begins harming himself or others, then emergency medical or police intervention must be called; but labeling someone in writing on the Interent, instead, is not good. The reality show movement seems to have inserted itself into mental health diagnosis and treatment.

Inaccurate Information Is a Diagnosis Of Doom

Source

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Comments 37 comments

janshares profile image

janshares 3 years ago from Washington, DC

Thank you, Patty, for the reminder that we all need to be on our ps and qs as we practice with changes to DSM. I get the Psych Central e-letter so I will look up that info on main changes. Great hub, informative, voted up and useful.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

I remember working in one psych practice that was still using DSM-III a few years after DSM-IV was published and the changes in the manual really showed up in insurance rejections.

The Psych Central e-letter is a great tool! I think we have more changes in the DSM-V than I expected and it's a little confusing.


janshares profile image

janshares 3 years ago from Washington, DC

There are also changes in CPT codes that will cause insurance rejections. Thanks again.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

That's right! What a mess we may have pretty soon.


carol7777 profile image

carol7777 3 years ago from Arizona

this was most interesting. It amazes me today all the labels. I know they are valuable. I remember when kids were unruly and difficult and now they have ADD etc. I wonder where all of this is going. Great hub. Voting up and sharing.


vespawoolf profile image

vespawoolf 3 years ago from Peru, South America

It's important that the current copy DSM-V be used for diagnoses, as well as that the diagnosis be made by a health care professional. It's also helpful to have the family involved so a proper diagnosis can be made as these issues aren't always clear cut. I love the photos you chose for this Hub. Thank you!


meloncauli profile image

meloncauli 3 years ago from UK

This is a great hub!

I wrote about how a mental health diagnosis affects teenagers recently. A diagnosis has powerful implications and can determine how that person's life continues thereafter with regards work, insurance, relationships etc. A diagnosis does need to come from a legitimate source.

Voted interesting.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

carol7777 - And about a half dozen new conditions, or at least new condition names, have been added to number V. Fortunately, I think that "Insufficient Personalty Disorder" has never made entry - it was proposed for adults of any age that had never worked. Thank how many might qualify for SSI on that diagnosis!

vespawoolf - We also have the situation where a diagnosis is needed for health insurance claim purposes, even if no Dx fits a client very well. Some clients don't want any diagnosis given about them, yet insist that insurance claims be paid. It's a headache. (The photos were a miracle that I found, imo! They are just right.)

meloncauli - Teens certainly are affected long-term by diagnoses! I heard recently from suppossed parents (possibly pranksters) claiming that their son has "x" diagnosis, but that he is adamant that he does not have it (he's 17), yet they refuse to get a second opinion and refuse to mention symptoms. I've a sense he'll just leave the household at 18, if he exists. The tip-off was their statement that he is a "textbook case" of a cluster of disorders of so many kinds and symptom overlaps that there is no textbook case to reference. Nasty business.


dragonflyfla profile image

dragonflyfla 3 years ago from South Florida

You make such a great point about the power that is given to the school system. I wasn't aware that teachers were allowed to dx students let alone change their medicine dose! How dangerous. We really need to bring the school system back to the local level and out of the politicians hands.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

I agree. This was also a case of a mental health practice having a contract with the schools with the incentive to find more kids with ADD/ADHD.


dragonflyfla profile image

dragonflyfla 3 years ago from South Florida

I remembering reading about that. The teachers liked the kids medication since they were able to manage their class better.


Ericdierker profile image

Ericdierker 3 years ago from Spring Valley, CA. U.S.A.

Excellent article. Very informative and helpful. I have seen labels do as much harm as guns. I would just bet that all of our horrible school age shooters were misdiagnosed and yet "publicly" labeled.


fpherj48 profile image

fpherj48 3 years ago from Beautiful Upstate New York

Patty.....You have presented an amazingly vital public service, here. I thank you.

I need to firmly state, THAT would be the day, I would allow and/or agree to have a TEACHER analyze my child and arbitrarily make changes to his treatment or Lord forbid, medications! What parent would ever? Forget I asked that.

I am brimming with comments, but this is not the place. Suffice it to say, the photo of the woman with "bananas on her head," offering psychiatric assistance for a dollar, says it all quite well!.....except that, even at a buck, she's over-charging ........UP+++


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

dragonyfla - Yes, exactly right the way you remember it. The story appeared on a newscast on TV and a weekly newspaper if I recall correctly. It reminded me of the abused spouses that were given antidepressants so they could stand to klive in the abusive home. Ack!

Ericdierker - I think there is truth to what you are saying. I wonder how often that has happened.

fpherj48 - "Bananas on the head"! When I see that in print, I am laughing, because we now have a new term for quack psych doctors! You are TOO brilliant! You must have a logo and a poster.

Thanks for the comments, Everyone!


MsDora profile image

MsDora 3 years ago from The Caribbean

Thanks for the information and the warnings. We do not pay enough attention to our own mental health and that of the people around us who just act "strange." It is not enough to see the doctor; we must see a qualified doctor and take our mental health seriously. Thanks for bringing these alerts to our attention.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

Hi MsDora - I hope that good mental heath services can reach more people in 2013!


haikutwinkle profile image

haikutwinkle 3 years ago

In most Asian societies, people don't really see a specialist/therapist when they showed various symptoms of a mental illness. It's really difficult to show them that they really need to see someone with a license.

Due to the limited budget schools have to hire a specialist, most children don't get the proper treatment for their behavior problems. Those little signs were often ignored until they turned into something more aggressive in adulthood.

Every now and then, there is one or two 'human accidents' on train tracks. If those little signs have been given the attention they needed, maybe it could have opened their minds a little wider...


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

@haikutwinkle - Thank you for sharing your insights and experiences. I am sorry about the deaths on the train tracks and about societies that do not make room to recognize serious illnesses until too late. We are thankful to have such specialists as are needed in many cities.


haikutwinkle profile image

haikutwinkle 3 years ago

I always love reading your posts. They are very informational.

Sometimes in my line of work, I would come across individuals who showed signs of a mental problem. I would always notice it instinctively because of the eyes and the energy they showed as a human being. I'm only trained in teaching, not in giving a therapy. In such a situation, my focus would be on one's use of vocabularies. Directing the individual to use more positive phrases when constructing a sentence. The positive effect on those students were subtle and sometimes what they needed is someone to talk to (though that is not solving the real issue in their hearts).


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

You helped your students a lot, haikutwinkle and I also see what you mean about the eyes and energy. The positive phrases might be very helpful to use with students and clients and I will remember that. You are a gem.


ajwrites57 profile image

ajwrites57 3 years ago from Pennsylvania

Patty Inglish, MS--very interesting. The mental health field and treatments of individuals cannot stand alone. Family, friends, teachers, employers and co-workers must care about the individuals and help encourage and monitor the afflicted person. The shootings that have occurred in recent years underscores this problem. The communities, families, mental health professionals and law enforcement were not sufficiently engaged with these individuals. It is all of our duties--not just out of compassion, but for community safety to monitor the hurting individual.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

Thaks for that additional insight, ajwrites57.


haikutwinkle profile image

haikutwinkle 3 years ago

Thank you, Ms Inglish for your encouragement. If you have a hubpage about creating positive vibes in various negative environment, I'd love to read it!


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

Thank very much. I have written about your question in small parts within other Hubs. Now may be the time to pull it together, so thanks for the idea!


Laura Schneider profile image

Laura Schneider 3 years ago from Minneapolis-St. Paul, Minnesota, USA

Excellent hub! Great reminders to health professionals and lay persons alike that we need to follow the rules: non-professionals NOT providing diagnoses on the internet, the new DSM V, and copyright violations. I'm not looking forward to the coding changes and inevitable mishaps, however, necessary though they may be. Thanks for the reminders that we need to be up-to-speed on these changes when the new DSM V becomes official! Well-written, logical, and helpful. Voted up and etc.


Patty Inglish, MS profile image

Patty Inglish, MS 3 years ago from North America Author

I appreciate your comments, Laura. I shudder at the upcoming confusion this spring as the new DSM goes into use and lay people continue to dianose ineffectively with the old DSM. On top of that, so many changes!


Jay C OBrien profile image

Jay C OBrien 2 years ago from Houston, TX USA

You said and I agree, "In the end, it cannot be overstated that a mental health diagnosis needs to be made by a properly trained and licensed or certified individual that has a proven track record of competence in mental health diagnosis and treatment."

Most of the above posts apply to the student/teacher relation. My question is: should the psychiatric community also assess our political leaders?


Patty Inglish, MS profile image

Patty Inglish, MS 2 years ago from North America Author

In its best reading, my article goes to the Patient/Therapist Relationship and the protection of the Mental Health Consumer. This is Number One in importance.

I never as an assistant, and would never now (or in future) as a professional, attempt to diagnose any person, unless I were in the correct setting, under correct cover of training, licensing and supervision, etc. However, others would do so.

Further, as an experienced professional, I am angry that unqualified lay persons analyze others without the discipline-wide accepted supporting evidence that they need to have, and recognized by them through adequate training and licensing. In addition, DSM and ICD changes need to be absorbed at once, while many of the diagnosing laity are unaware that changes even occur..

Non-professionals may be able to recognize a few symptoms of mental illness - and humans all should be taught to do so - but the troublesome persons who delve wrongly into others' mental health only skim the surface, especially of SMD operations, and they flounder below that shallow surface with which many are in touch.

Until or if such becomes law, should any psychiatrist or psychologist secure agreement from our political leaders to each undergo a full-battery professional analysis, the results might be enlightening -- Our Astronauts undergo such a process. To assess politicos without appropriate one-on-one interviews, histories, past Dx's/Tx's, testing, etc. is incorrect. A 15-minute faux psychiatric analysis done TO, not FOR, a goodly number of clients in W2W programs in some cities in the recent past produced an uncountable number of false diagnoses and giant problems.

But, at what level of mental health malfunction do we prevent a person from holding office? After all, we cannot decide that yet for gun sales; holding office might be more complex a set of requirements.

Thanks for the question!


Jay C OBrien profile image

Jay C OBrien 2 years ago from Houston, TX USA

That is a very lengthy answer. History is filled with stories of leaders who have done some very terrible acts. I have often wondered why the psychiatric community did not point out their mental illness before they acted. How did these leaders get into office or stay in office?

What I am suggesting is a panel of experts who follow the protocols and analyze leaders on a regular basis. How else can a determination be made except by a panel of experts and proper analysis?

The real questions seems to be: How would a panel of psychiatrists get access to a political leader? Would he permit it? How about a mental health warrant for leaders who preach violence?


ajwrites57 profile image

ajwrites57 2 years ago from Pennsylvania

lol I'm sure you are serious with your question Jay C OBrien, but the politicians would never sit for it! The field of candidates would get mighty thin! Yes, Patty Inglish, MS, we require this scrutiny for gun sales and astronauts, but not politicians. Just like we don't require ID to vote but we do to be able drink or smoke! (But that's a tale for another day!) As far as diagnosis of individuals with MH issues, maybe the entire field needs to be revamped in such away that serves more people in better ways. The educational and clinical requirements for MH professionals often turns out elite academics as opposed to helpful professionals. Just sayin.' (Love your articles Patty English!)


Patty Inglish, MS profile image

Patty Inglish, MS 2 years ago from North America Author

Excellent and spirited posts, J C O'Brien and ajwrites57! It's a lot to think about. A revamp might be good.

I don't know about the wisdom of a panel invoked for preaching violence - how much violence, exactly? Defending borders or one's family might be seen as violent. War certainly is violent. Invading countries for no reason is too much violence, imo. These days, if a person loses his temper, even justifiably, people point and shout BI-POLAR! If someone stands up for herself on a podium and insists on a piece of legislation being worthy and correct for the largest number people in the USA, then people point and yell NARCISSISTIC! Who else is tired of that?


ajwrites57 profile image

ajwrites57 2 years ago from Pennsylvania

Patty, I'm tired of people expressing themselves and having people that disagree with whatever the opinion call the opinions racist, or homophobic or whatever. lol


Patty Inglish, MS profile image

Patty Inglish, MS 2 years ago from North America Author

Yes, that is completely tiring.


Jay C OBrien profile image

Jay C OBrien 2 years ago from Houston, TX USA

Perhaps I am not articulate. Let me try again. Read history and you will find people who have attained great power with the consent of the people, yet have done terrible things during ascendency and when in power.

Is it possible to use existing mechanisms to evaluate their mental health? A warrant does not require their consent. What is the duty of the psychiatric community?


Patty Inglish, MS profile image

Patty Inglish, MS 2 years ago from North America Author

A warrant or court order for psych analysis may work. Should we obtain such warrants in the case of political leaders? I am not yet sure, but you bring an interesting possibility forward.


Jay C OBrien profile image

Jay C OBrien 2 years ago from Houston, TX USA

Thank you. We should at least try to control our own leaders. I believe everyone can agree that we do not want mentally ill people in power. The method I leave to the Psych community.

As an aside: Carl Jung commented on Hitler's handwriting being, "feminine." I wish Carl Jung would have gone further in the analysis.


Patty Inglish, MS profile image

Patty Inglish, MS 2 years ago from North America Author

Thanks for that information!

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