What are the current challenges in diagnosing mental disorders?

Introduction
Problems of categorization
The stigma of mental illness
Treatment differences in low- to middle-income countries
Problems in rich regions
References
More information


As part of our coverage of World Mental Health Day 2022, News Medical explores the current challenges in diagnosing mental disorders.

Mental and substance use disorders are the leading cause of disability worldwide. There are 450 million people worldwide with a mental disorder, and 25% of the population will suffer from a mental illness in their lifetime (Carbonell et al., 2020; WHO, 2017). Meanwhile, more than 26 million people worldwide have been diagnosed with severe mental illness.

Currently, there are several challenges in diagnosing mental disorders, from the common to the more severe. These include problems that range from how mental disorders are categorized to how they are perceived, and that suggests they are diagnosed at all: there are problems with access to services that are ineffective and need to change.

Problems of categorization

Although there has been an unprecedented expansion in our knowledge of mental illness over the past half century, our understanding is still in its infancy. There are currently three systems or approaches to the diagnosis and assessment of mental conditions. These are:

  • The International Classification of Diseases
  • Diagnostic and Statistical Manual of Mental Disorders
  • National Institute of Mental Health Research Area Criteria

The first two are diagnostic manuals that present classification systems applicable to public health, clinical diagnosis, service delivery, and specific research applications. The second guide is relevant to the US. Meanwhile, the third approach listed refers to a framework emphasizing the integration of basic behavioral and neuroscientific research with a view to better understanding mental disorders.

According to Clark et al. (2017), four key issues currently hinder the adequate understanding and classification of mental disorders. These are:

  1. Etiology – including multiple causes of mental disorder
  2. Discrete – whether the relevant phenomena are discrete categories or dimensions
  3. Threshold – which defines the boundaries between disorder and non-disorder
  4. Comorbidity – people with mental illness often meet diagnostic criteria for multiple conditions

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The stigma of mental illness

It is now well known that insufficient knowledge and understanding of mental illness hinders effective treatment. People with mental health problems in entertainment have been stigmatized and faced discrimination. The problem is not unknown these days either.

Stigmatization of mental illness is recognized as one of the main obstacles to closing the aforementioned mental health gap. The problem is serious, leading to delays in seeking treatment and possible social exclusion and isolation of those affected. The negative perception surrounding mental illness easily reaches beyond the patient. It is also found among future health professionals who may be inclined not to choose this specialty, thus exacerbating the shortage of personnel in this sector.

WHO Science in 5: Mental Health

Treatment differences in low- to middle-income countries

There is a phenomenon known as the “mental health treatment gap.” Worldwide, more than 70% of people currently do not have access to mental health services (Wainberg, et al., 2017). The problem is particularly acute in low- to middle-income countries, some of which still do not have a dedicated budget for mental health care.

To address the ‘treatment gap’, the World Health Organization (WHO) developed the Mental Health Gaps Action Program Intervention Guidelines. Although designed to be user-friendly, several issues have hindered their successful optimization to date, such as low numbers of mental health practitioners, low levels of research, mental health stigma and segregation of mental health services.

Problems in rich regions

The problems are not limited to poorer countries. Research shows that mental health services in wealthier countries are often ineffective. In the UK, for example, it is typical for mental illness to be treated in centralized psychiatric services or clinics rather than in primary care settings. This means that people in urbanized areas are at a distinct advantage when it comes to accessing services compared to those who live further away in more rural areas and the community as a whole.

To address the issues, in 2013 the World Health Assembly adopted a Comprehensive Plan of Action on Mental Health 2013–2020. This asked United Nations (UN) member states to integrate mental health care into the setting for primary care. Its intended scope was to include both common and severe mental disorders.

We currently know that people with mental disorders have a reduced life expectancy of about 10-15 years. Early intervention from the age of first onset can dramatically improve this grim prognosis. But currently, mental health care systems typically separate services for adults and children.

More needs to be done. Calls for more integrated health systems that reach out to people in the wider community and include models of mental health that move us away from the biomedical model represent an opportunity to promote improved service for all.

Image credit: Paul Craft/ShutterstockImage credit: Paul Craft/Shutterstock

References

  • Carbonell, A., et al. 2020. Challenges and barriers in mental health systems and their impact on the family: a systematic integrative review. Health and social care. Doi: 10.1111/hsc.12968
  • Clark, L. et al. 2017. Three approaches to understanding and classifying mental disorders: ICD-11, DSM-5 and the National Institute of Mental Health (RDoC) Research Area Criteria. Psychol Sci Public Interest. Doi: 10.1177/1529100617727266
  • Saxena, S. et al. 2013. World Health Assembly adopts comprehensive plan of action for mental health 2013–2020. Lancet. Doi: 10.1016/S0140-6736(13)61139-3
  • Solmi, M. et al. 2022. Age at onset of mental disorders worldwide: a large-scale meta-analysis of 192 epidemiological studies. Molecular psychiatry. Doi: 10.1038/s41380-021-01161-7
  • Wainberg, M. 2017. Challenges and opportunities in global mental health: a perspective from research to practice. Curr Psychiatry Rep. Doi: 10.1007/s11920-017-0780-z
  • World Health Organization. 2007. Everyone’s Business – Strengthening Health Systems to Improve Health Outcomes: The WHO Framework for Action. Online: https://apps.who.int/iris/bitstream/handle/10665/43918/9789241596077_eng.pdf

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