4 DEFINITION OF MENTAL DISORDER
including personality disorder
4.1 The question asked was 'Do you think it possible/appropriate to define mental disorder on the basis of need rather than diagnostic category?'
Although a majority of respondents (62%) thought that people should be considered on the basis of need rather than their diagnosis, the comments made it obvious that both have their uses. For some purposes, e.g housing, 'need would be preferable, but diagnosis is relevant for proper medication and for social services support'.
It may take time to get a diagnosis.
- 'it is difficult to come to a definite diagnosis until quite a lot of time, stress, distress and worry has happened'
- 'diagnosis can cake years and professionals can take different views and be reluctant to make a diagnosis. Meanwhile, patients are in need of care and families are in limbo, unsure and ignorant of how to act for the best'
- 'early diagnosis is a great help. It took 3 years with one doctor giving no diagnosis and one visit from another to make a diagnosis. Then, after a short hospital stay, I was given the correct treatment'
Both carers and the service users can be disadvantaged by such long delays.
- 'the carer can find it easier to cope if a diagnosis is given. The service user may have difficulty getting benefits if there is no diagnosis'
- 'there are difficulties in accessing services for people who may be in very great need but do not have an official diagnosis'
- 'I have no diagnosis and a big problem accessing services'
Both the diagnosis and the needs may change.
- 'diagnosis may be wrong but the needs are obvious'
- 'diagnosis can change after a while but needs remain'
- 'diagnosis can be difficult and can only be confirmed after a long period. Needs change'
- 'I became more vulnerable when pregnant so that my needs changed'
Individuals may have the same diagnosis but very different needs.
'my son needs 24-hour care in a safe environment but other patients who have schizophrenia have different needs'
'diagnosis gives too rigid a description for types of illness that can vary so much in each manifestation'
'same diagnosis for my son and daughter whose illness has had a more stable course and more hospitalisation'
'people react to life's crisis in different ways. Levels of support for individuals vary enormously. People also have different responsibilities and commitments. What one person may cope with, another may not'
'no two people have exactly the same symptoms of their disorder'
'the individual's situation is very important to me as I feel that every person is different and has different needs'
People may also have similar needs without having the same problems. For example, someone with a mental health problem and someone with a learning disability may have a need for accommodation but they should not necessarily be treated in the same way.
If needs only are considered:
'Government shouldn't use this as a means of denying people financial or medical help'
'it might help to produce more sensitive and useful care plans, based on input from the recipient and the provider of services rather than on clinical decisions based on clinical diagnosis'
If diagnosis only is considered:
'once diagnosis is given, then the only route appears to be medication with no examination of other means of help. This leads to closed minds and condemnation to a life of failure and no hope'
4.2 Personality disorder
In our first response to the Committee, NSF(Scotland) expressed concern that a change in diagnosis to/from personality disorder, from another diagnosis, might affect individuals' access to services. 11 % of people who responded to the relevant question reported this experience (14% of service users, 9% of carers). We asked respondents to tell us what the effect of this was on support services offered or received (for better or worse).
There is no doubt that there is a different attitude to people with a personality disorder as compared with severe mental illness and this does affect both treatment and services.
- 'support services changed for the worse' (a service user)
- 'it had a terrible effect on treatment or rather non-treatment and non-admission to hospital in spite of very serious suicide attempts and a very vulnerable lifestyle. My daughter was open to all kinds of dangers. Later she was diagnosed as having schizophrenia/schizoaffective disorder'
Changes in diagnosis cause great puzzlement and distress when one individual is given successively diagnoses of perhaps drug-related psychosis, later schizophrenia, then manic depression, now schizoaffective disorder with bi-polar manifestations (euphoria/mania followed by deep depression). Both service users and informal carers need some explanation.
Personality disorder is a vague term and people are not clear how it is arrived at.
- 'staff initially did not listen properly to our description of our son's symptoms. He was first classified as having personality disorder. I firmly believe that there are many people in prison and community who have a range of illnesses and personality disorder and should be on anti-psychotic medication'