Mental Health Assessment Procedures
Assessments range in formats, styles, and orientations. Historically, they have been as divergent, as they may be conflicting, capricious, and grossly unreliable. Though the validity and reliability of each individual type may be offered as evidence based, “there is little research examining the consistency between them in terms of what symptoms they assess, and how they assess those symptoms.”
In the same 2020 article, the highest level of concordance between differing assessment modalities was 58%, while collectively, 60% of symptoms being evaluated were assigned to half of all mental health disorders. Symptoms-overlap, biases, assessment-duration, abstruse chronicity criteria, and the absence of clearly articulated levels of severity, further exacerbates the daunting task of diagnosing and treating mental health conditions.
1Psychiatry, 27 February 2020 | https://doi.org/10.3389/fpsyt.2020.00076
Considering that spending on mental health in 2020 amounted to $1.4 trillion, making it the single most expensive medical condition in the U.S., one may wonder within a labyrinth of confusion in search of sanity. Mental health services are supposed to be focusing on the care, prevention, and treatment of mental disorders and through them maintain, improve, and restore the mental health of the population; and yet in a study published by "The US National Library of Medicine, National Institutes of Health...of the 840 primary care patients assessed, misdiagnosis rates reached 65.9% for major depressive disorder, 92.7% for bipolar disorder, 85.8% for panic disorder, 71.0% for generalized anxiety disorder, and 97.8% for social anxiety disorder."
It is obvious from the above accounts that immediate research and care is imperative for (a) the development of assessment tools, (b) improvements in assessment skills, and (c) the elimination of the DSM as the Bible; more in tune with economic considerations than with the quality of of diagnosis and treatment.
In an online search of a few hundred Scholarly articles for graduate training in psychotherapy, psychology, Family Therapy, and Mental Health counseling, not a single source has undertaken a comprehensive study of curriculums, or State requirements. Combining this, with a search of 35 different University graduate programs in Mental Health leads to a conclusion that none of them require more than 6 credits in assessments, or diagnostics, or even the traditional Mental Status Exam.
As for therapeutic orientations and modalities, aside from a single generic course in "Theories," the emphasis is on Behavioral and Cognitive psychology.
3Prim Care Companion CNS Disord. 2011; 13(2): PCC.10m01013. doi: 10.4088/PCC.10m01013
Psychiatric Assessment in Primary Care.
Deficiencies in the training of primary care physicians has prompted researchers to point out the importance of improving physician' competency skills in assessing, treating, and managing patients with indeterminate or arcane disorders.
Others demonstrate that health care ought to address issues associated with diseases that appear to coexist in the same person, e.g., depression in parallel with addiction. According to a study reported in "Psychiatric comorbidity"in 2005, 48.6% of patients with a diagnosis of major depression also had at least one anxiety disorder
In another research project we join with the conclusion that "over‐reliance on the traditional unstructured clinical interview can cause a health provider to under‐recognize co‐morbid conditions, and that making efforts to gather as much information as possible can help reduce inaccurate diagnosis.
5Maj M. "Psychiatric comorbidity": an artefact of current diagnostic systems? Br J Psychiatry. 2005;186:182-184. doi:10.1192/bjp.186.3.182
There is additional evidence elucidating that in primary care there is no agreed method for assessing or documenting a patient's psychiatric symptoms. In fact, the US Surgeon General noted that, as it currently stands, primary care ‘has limited capacity to identify patients with common mental disorders and to provide the proactive follow‐up that is required to retain patients in treatment.
6Ment Health Fam Med. 2010 Mar; 7(1): 17–25. PMCID: PMC2925161 PMID: 22477919
7Mental Health Fam Med. 2010 Mar; 7(1): 17–25. PMCID: PMC2925161 PMID: 22477919
Notes on the Assessment Process
First off, screenings and assessments ought to be done by well trained and qualified professionals whose knowledge is diversified among different theoretical orientations and supplemented with experience.!
Though States sanction many professionals to perform "Diagnostic Assessments", the truth is that the greatest majority of professionals have had little, if any, training -other than the DSM- in this crucial area of mental health service.!
Moreover, as it is right now, because of insurance mandates and guidelines, the diagnostic process MUST lead to a reimbursable medical, or mental health condition; even at the expense of misdiagnosis, or intentional misdiagnosis.
The result being that about 90% of all people being diagnosed are labeled as Depressed, Bipolar, Add/Adhd, Ptsd, or some form of a Dual Diagnosis that includes addiction. !
In deference to academic needs for a more robust clinical training, the objective of the section on Assessments' is three-fold;
Going further; not only do we need to tweak the general categories detected, but sub-categories under each label. e.g. Mood Disorder : Bipolar mixed, Bipolar Depressed, Bipolar Manic, Dysthymia, cyclothymia, Grieving, ... Doing so, involves diligence in recognizing that many depressive symptoms may not be the result of a mood disorder, but rather within the presence of addiction, or anxiety, or OCD.
Failure to do so, may result in offering anti-depressants like "Prozac" or "zoloft" to an individual with substance abuse, or one suffering with panic attacks.!
- to simplify, to elucidate and to present important psychological concepts in a coherent and distinct fashion;
- to extract and present basal assessment signs and symptoms common accross all interview protocols of utility to ruling out one or more of many mental health constellations.
- to employ differing treatment modality theories as the basis of specialized assessment and diagnostic protocols.
- to offer Specific Medical Evaluation-protocols of assistance in narrowing down diagnostic categories and conceivable etiologies.
- on how to utilize this knowledge in order to elicit a patient’s active participation in a more effective fashion