The use of diagnoses in mental health service eligibility and exclusion criteria

Abstract

Background

Diagnoses are controversial but ubiquitous in mental health; however, whether they are essential features of service entry has not been analysed.

Aim

To investigate the use of diagnosis in the service entry criteria of UK NHS adult mental health services.

Methods

Freedom of Information requests were made to 17 NHS adult mental health Trusts; responses were analysed thematically.

Results

Four service types were identified: broadly diagnostic, problem-specific, supporting specific life circumstances and needs-led. Diagnoses were used frequently but not universally. Non-diagnostic factors were central to service entry criteria.

Conclusions

Diagnoses were neither necessary nor sufficient in-service entry criteria. Broad clusters of difficulties were used rather than specific diagnoses. Extensive exceptions revealed diagnoses as inefficient proxies for risk, severity and need. Differences across criteria appeared largely driven by professional competencies. Implications for innovative care pathways include preventative services and working with psychosocial factors.

Keywords:

• Mental health services
• service eligibility criteria
• psychiatric diagnosis
• innovative services

Disclosure statement

Professor Kinderman is employed by the University of Liverpool and has received funding from a number of research charities and Councils.

Author contributions

Data collection and analysis was carried out by Kate Allsopp. The manuscript was written by Kate Allsopp and edited by Peter Kinderman.

Additional information

Funding

Dr

Allsopp reports grants from University of Liverpool as part of a PhD scholarship during the conduct of the study.