News and Views

Person-Centred Care: Beyond Diagnosis

Mental health diagnoses can seem at first glance, like a set of well-defined illness that we can clearly and objectively say an individual has or does not have. In reality however, mental wellbeing is much more complicated and subjective to individuals. In their article in response to the release of the American Psychiatric Associations diagnostic Manual (DSM-V), Kinderman, Allsopp & Cooke (2017) discuss the importance of considering diagnoses as a product of their time and societal context. The importance of an individual’s experience both in terms of negative life events, and negative experiences living in an often toxic society, can easily be forgotten. Young people are particularly prone to this as often they do not have the means or power to change their circumstances.


Kinderman, Allsopp and Cooke (2017) argue that mental health diagnoses are simply a product of their time. In the early 1900s Psychiatrists and Psychologist may have diagnosed people as being neurotic, shell-shocked or melancholic. These diagnoses no longer exist. Incredibly, homosexuality was until as late as 1992 consider a mental illness by the World Health Organisation.


Diagnoses are a product of the time and context in which they are given and are not fixed constants like for example a heart attack is the same process it has always been. Current diagnostic systems are particular focused on the individual, often removed from context without taking into account societal influences.


Young people may be negatively affected by the society around them. Young people often talk about bullying. Whilst sadly, this is not a new phenomenon, bullying online makes it harder for young people to escape. Where home might have been a place of sanctuary, this may now continue through mobile devices. Furthermore discrimination appears to be increasing amongst minority groups, including Black, Asian and minority ethnic communities (BAME) and people who identify as LGBT. Discrimination and abuse may account for the higher levels of emotional distress amongst minority groups.


Since the financial crisis in 2008, the UK has seen an increase in inequality in which more families are using foodbanks and living in temporary accommodation. For those more fortunate, changes in circumstances may have resulted in changes in school, more parental stress, and increased number of parental working hours. All these factors, whilst unavoidable, can result in young people experiencing increased levels of emotional distress. Poverty and financial stress have also been associated with higher rates of emotional distress.


All of these factors and many others can have an effect upon our mental wellbeing, however it is often through young people we can see the increasingly distressing effects of society and context upon mental health.


Moving beyond diagnosis also presents an opportunity for people to access services based on their individual need. Here at Psicon, our Children, Young People and Families service aims to support people based on their experiences. We will help co-create Person-Centred care plans with the young person and key people in their lives in order to support their individual wellbeing. We will take into account how societal factors may influence the young person’s experience, in a supportive, non-pathologising manner. Key to our approach is that the young person is not ‘the problem’ but may be part of system that may result in the experience of emotional distress. This is not a fixed constant, but something that with the right support, we aim to help elevate.


Dr Stephen Wright

Clinical Psychologist