Diagnostic approaches to mental illness assessment by different mental health professionals

¶ … professionals who are trained in the identification and treatment of clients with mental illness. 2. Identify and discuss all the key elements in assessing a person for mental illness, i.e., what factors MUST be considered by staff? 3. (a) Identify and discuss the critical areas to assess in a suicidal person. (b) Specifically address the issues of safety and self-harm. (c)Discuss risk factors and differences such as age groups, gender, culture, and religion. 4. (a) Discuss how confidentiality plays into all of this. (b) Include one or two paragraphs about the "new" HIPAA (Health Insurance Portability and Accountability Act) standards. (c) Then answer the following: How will HIPAA affect mental health providers and consumers? (You will need to be creative with this question and "think outside of the box")."

Seeking Aid, Offering Help

Millions of Americans are affected either directly or indirectly by mental disorders, either struggling with a range of symptoms themselves are trying to help a loved one get the kind of help that they want and even need. Many people who are struggling to overcome the barriers that mental disorders place in their lives simply live with their disabilities for years, even decades, in part because they may not know how much help is available for them and in part because of the enduring stigma that is attached to mental disorders. Finally many people will be driven to seek out professionals to provide the kind of accurate diagnoses that will help them get the treatment that they need. If it is a person's first time attempting to get professional help she or he may not exactly know whom to go to -- a psychiatrist? A psychologist? A therapist? A social worker? Or just the family doctor? Each of these professionals has training that will allow him or her to assess mental illness in a patient or client -- although given their respective training and the biases that exist in each profession the diagnosis and follow-up treatment will differ (Hood & Johnson, 2006, p. 81). In this paper I will assess the ways in which three different types of professionals diagnose those with mental disorders, comparing and contrasting the ways in which these three types of professionals vary in their approaches to diagnosis and treatment.

Other Conditions Concerning Suicidality and Confidentiality

It is important to note that the clinician would also want to assess other factors that contribute to the possibility that a person is genuinely suicidal -- although in the case of someone like the above described hypothetical patient there would be no significant need to do so, since that individual has clearly passed into the realm of being at extreme risk for suicide. In a more ambiguous case, the clinician would want to consider factors such as previous suicide attempts (which would increase the possibility that an individual would try to commit suicide again) and whether a family member or close friend had committed suicide, as these also increase the chance that an individual might attempt suicide.

The clinician would also want to assess for underlying physical problems that might make it difficult for the person to make rational decisions about suicide. For example, if the patient or client was psychotic or schizophrenic (one could be both, of course) or suffering from a form of dementia, he or she might not be capable of the kind of reality-testing that most of us can do when determining whether or not life is worth living. If they are incapable of making an accurate internal diagnosis, then such individuals must be considered to be at higher risk for suicidality.

Before going on to discuss the ways in which three different types of clinical professionals would assess a patient or client for threats to another individual, which brings us to the issue of confidentiality. With a very few exceptions, anything that a patient or client tells a clinician must be kept confidential by the clinician. This includes information that might seen in commonsense terms to need to be reported to someone else, such as the fact that the client or patient is breaking the law. But mental health professionals, and medical professionals in general, are not members of any police force, and so if a client or patient reports that she is embezzling company funds or that he is blackmailing his ex-partner, these are not things that the clinician is allowed to tell anyone else. (This does not, of course, mean that the clinician would not help the client examine these behaviors and develop better means of coping that do not involve breaking the law!)

However, if a client or patient is harming a child, an elder, or a developmentally delayed adult, or is making a specific threat against a named individual, then the clinician is legally required to report this harm to the appropriate agency (such as Child Protective Services, Adult Protective Agencies, the police, etc.) In a follow-up to the preceding discussion about suicide, mental health and medical professionals are not required to report suicidal feelings and plans to any outer agency, but they are permitted to do so. This is an important distinction: Clinicians are mandated to report harm to others but are permitted but not mandated to report suicidal feelings.

Finally, before I turn to an analysis of the ways in which different types of clinicians approach the process of diagnosis and assessment I want to mention the last but in most cases central set of concerns that a clinician has when meeting with a client or patient. While issues of suicidality and potential or actual harm to others must always be assessed, for most clients and patients these will be absent. What brings most people to a mental health professional and therefore is most important to both clinician and patient are the symptoms that the individual is suffering from that are interfering with her or his ability to complete daily activities (such as attending classes or even getting up and getting dressed). Beyond the ability of the individual to carry out daily activities, there is the issue of quality of life. So a person who can get up and go to work but finds no pleasure in normal activities is someone whose symptoms still merit concern from the mental health professional (Hood & Johnson, 2006, pp. 27-9.)

Psychiatrists: The Medical Model of Treatment

For many people the most obvious professional to seek treatment from when faced with the symptoms of mental disorders is a psychiatrist. (Maybe because we've grown up reading the psychiatry cartoons in The New Yorker!) Psychiatrists are medical doctors and so their basic response to the symptoms of mental disorders will tend to be a medical one. This encompasses an overall examination of the person's health. (For example, a psychiatrist might run a series of thyroid function tests to determine if a patient's depressive symptoms were related to thyroid problems rather than another underlying issue.) A psychiatrist would also consider underlying biochemical reasons for a person's symptoms. For example, if a patient reported symptoms of depression, a psychiatrist would certainly at least consider prescribing an anti-depressant such as Cymbalta or Effexor. If a patient reported high levels of anxiety, a psychiatrist might prescribe an anti-anxiety drug such as Xanax. And if a patient reported obsessive or compulsive tendencies then a psychiatrist might prescribe a medication that helps remedy such impulses such as Paxil.

Psychiatrists should -- although they do not always succeed at this -- consider the entire set of circumstances of a patient's life, as this description makes clear:

Psychiatry is a branch of medicine: it deals with those disorders in which mental (emotional or cognitive) or behavioural features are most prominent. The cause, presentation, and course of such disorders are influenced by diverse factors; their symptoms can be bewildering to patients and their relatives; and their management may require social and psychological as well as medical interventions. It is not surprising that this complex situation can lead to misunderstandings of the role of psychiatrists (who are neither social workers nor jailers) and myths about the practice of psychiatry. (Davies 1997, p. 314).

Psychiatrists are (or at least generally are) given training in the central therapeutic techniques such as empathy. However, many psychiatrists do not find a traditional therapeutic approach to be comfortable and so may essentially outsource this aspect of treatment to another type of clinician in the field, such as a therapist (Suzuki & Ponterotto, 2007, p. 41).

Marriage and Family Therapy

Marriage and family therapists (the term varies to some extent from state to state and has changed over time) have master's degrees in counseling or psychology or a related field. Their focus on a client is the person's relationship to others as well as to herself or himself. Because the focus of therapy is to improve the individual's relationships, assessments on the part of the therapist will focus on symptoms and feelings that interfere with healthy relationships (Suzuki & Ponterotto, 2007, p. 119). So, for example, if a client reports that he is unable to form authentic, lasting relationships with others, the therapist would work with the client to uncover the origins of this limitation (this work would thus follow traditional psychodynamic therapy). After the client had a better sense of insight into the origins of his behavior, the client and the therapist would work together to change the client's behavior towards others (which might take the form of cognitive behavioral therapy).

Both therapists and psychiatrists depend on the same basic parameters for diagnosis -- The Diagnostic and Statistical Manual in its current form (the revised fourth edition at the moment, with the fifth edition on the horizon). Both professions agree in general on what constitutes a mental disorder but vary in their understanding of the origins and best treatments for these disorders (Groth-Marnat, 2009, p. 81).

Social Workers

Social workers are also responsible for assessing and designing treatment plans for clients with mental disorders. However, as their title suggests, their approach is somewhat different. While psychiatrists tend to look first to medical reasons and possible treatments for mental disorders and therapists tend to look to relationship issues as being fundamental, social workers are trained to look first to the pragmatic elements of the individual's life. Social workers (who hold master's degrees in social work or a related field) tend to look first to issues like providing adequate housing, schooling, and nutrition to an individual and her or his family than to the biochemical nature of disease or long-term attachment issues (for example).

HIPPA

Ideally, most individuals with a mental disorder could benefit from a range of services, including therapy to look at problems in relationships, a general doctor to assess overall health, a psychiatrist to prescribe psychoactive drugs when needed, and a social worker to help with problems with everyday life. To this end, HIPPA -- the federal act that requires significant protections for a patient's or client's rights -- may actually interfere with the provision of the kind of intersection of a variety of services that most individual needs. As health professionals become increasingly wary of potential violations of HIPPA (not that confidentiality is not important, but sharing of information among a team of professionals working with an individual is also important) there well may be less sharing of the kind of information that would help those facing the immense challenges of mental illness (Suzuki & Ponterotto, 2007, p. 245).