‘I’m not insane, my mother had me tested’: the risk and benefits of being labelled ‘at-risk’ for psychosis

Abstract

In this article we examine the identification of young people deemed to be at an elevated risk of developing psychosis (often referred to as an At-Risk Mental State for psychosis). Although this is not a new concept within psychiatry, there has been a growing interest in this topic because of the proposed inclusion of an official ‘Psychosis Risk Syndrome’ in the 2013 Diagnostic and Statistical Manual. Although we discuss the risks and benefits associated with the categorisation of individuals based on the concept of risk itself, we also draw upon observations from one of our own research studies. We interviewed six adolescents with an identified At-Risk Mental State analysing the data using an Interpretative Phenomenological Analysis framework. We identified three key themes: ‘It is better to say it’, ‘How others would take me’ and ‘Just to have somebody to talk to’. Within these themes, participants endorsed risk identification as a means of personally justifying and explaining their current symptoms, as well as providing a sense of optimism that their condition was not yet fully formed. Concerns regarding stigmatisation were identified although rarely experienced. These findings indicate that there are indeed personal benefits for screening for psychosis risk in young people, despite the ‘undesirability’ of identification reported in other areas of health. The benefits observed may reflect genuine differences in adolescent mental health or the methodological constraints of this exploratory study. Nevertheless, the results contribute to the understanding and ongoing debate of screening for illness in potential ‘at-risk’ populations.

Keywords:

• categorisation
• risk
• psychosis
• mental health
• young people