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Written By Legacy Healing Center - Jul 15 2020
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Diagnosing mental health conditions can often be challenging as it requires full transparency by the patient, a vast knowledge of mental health modalities and treatments by the provider, and the ability to assess all aspects of the patients’ lives and how they affect the symptoms they present with. According to a 2012 study done by the Royal College of Physicians, Bipolar Scotland, and Bipolar UK; 85% of participants had a delay in diagnosis causing 71% of people to experience worsening of symptoms. Inappropriate treatment for mental health diagnoses, specifically Bipolar, is especially dangerous as it has been associated with an increased risk of suicide.
Several factors contribute to the misdiagnosis of mental health. Dr. Ash Bhatt, Medical Director at Legacy Healing Center explains where the biggest problems lie:
“Those of us who treat patients with mental and emotional diseases are dealing with an abstract concept: The mind. We can’t palpate, auscultate, or obtain an MRI of the mind. We treat disorders of emotions, feelings, behaviors, perceptual disturbances, and thought.
Yes, there are advances in neuroimaging, measurement of biomarkers, and metabolic rates, but this is still a novel concept when it comes to its mainstream utilization. We do not have the luxury, if you can call it that, of physical examination, diagnostic imaging, laboratory results, or biopsies to assist us in diagnosing or treating.
Psychiatrists rely on an interview with patients who are often depressed, anxious, manic, psychotic, and in many circumstances incapacitated and unreliable. In any setting, from emergency rooms, to inpatient floors, to outpatient offices, we rely on a semi-structured diagnostic clinical interview to guide us to the most probable diagnoses and ultimate treatment. This requires time, and this is where the big problem lies.”
Metal health misdiagnosis can also occur when patients do not fully disclose all their symptoms. Suzanne Hudson, chief executive of Bipolar UK explains, “A lot of times it’s patients themselves not telling the doctor their full symptoms. If were in a hypomanic state, coming out of a stable phase and starting to get high, we rarely present to a doctor then, which makes it more difficult.” For most patients, identifying depressive symptoms is easier because it is an unpleasant experience, but if you are in a hypomanic state and you feel good, it can seem unnecessary to report that to your provider. When not directly asked about these symptoms, patients may not understand the importance of disclosing them as it relates to their treatment. Some patients have also disclosed feeling shame or embarrassment of their symptoms leading to these keys points not being discussed with their provider.
Additionally, there are cultural factors that contribute to misdiagnosis. Erica Goode, writer for The New York Times, wrote “African-Americans, for example, are more likely to receive misdiagnosis of schizophrenia and less likely to receive accurate diagnoses of depression or other mood disorders [according to a U.S. surgeon general’s report].” She goes on to say “And while rates of mental illness in Asian-Americans do not differ significantly from those found in other groups, mental health professionals hold the stereotype that they are ‘mentally healthier’, a bias that contributes to inadequate treatment and prevention.” While treatment and understanding of mental health has come a long way in the last several years, it is clear that there is still much work to be done to better serve those who struggle with mental health.
Dr. Bhatt explains another cause of mental health misdiagnosis as patients being given an incorrect diagnosis in the past and are essentially labeled in future evaluations. He explains:
“Patients who were previously diagnosed ended up often being treated solely on their self-reported “past psychiatric history” without any attempt by the physician to explore and elicit the appropriate criteria warranting such a diagnosis and ultimate treatment, which only can be done by conducting a thorough diagnostic psychiatric interview. So essentially, they are stamped and labeled with their previous often self reported inaccurate diagnoses and then additional diagnoses are added on by various providers solely on the history of presenting symptoms or illness without “truly diagnosing them”. It is a conveyor belt of sorts, assembling a trail of misdiagnoses and inappropriate treatment.”
Misdiagnosis can cause an already vulnerable patient to have increased feelings of hopelessness due to treatments being ineffective. Inappropriate treatments places patients at risk of developing new symptoms due to taking medications that do not address their symptoms. The National Alliance on Mental Illness states, “Historically, African Americans have been and continue to be negatively affected by prejudice and discrimination in the health care system. Misdiagnoses, inadequate treatment and lack of cultural competence cause distrust and prevents many African Americans from seeking or staying in treatment.”
At Legacy Healing Center, treatment will begin with a comprehensive psychological assessment, done by trained psychiatrists in order to get a holistic view of your needs. Dr. Bhatt explains the process:
“Patients with emotional and mental illness need a thorough, sophisticated diagnostic evaluation. It incorporates appropriate history taking from birth to the present, considering biological, psychological and social influences as well as placing symptoms in the appropriate context and domains while seeking out any necessary collateral and corroborative histories. All aspects from the chief complaint, history of present illness, past psychiatric/suicide and substance abuse history and treatments, family psychiatric/suicide and substance abuse history, legal history, birth and developmental history, medical and surgical history, current and past medications history and trials, educational history, social history and a mental status examination needs to be conducted on all patients who are to receive a diagnosis by that practitioner. That practitioner has to elicit the diagnosis and be able to validate it. Necessary medical and lab work-ups should be done.”
We encourage family to participate in the diagnostic process as it allows us to gain insight into behavioral and emotional health. Clinicians at Legacy Health Center provide a supportive environment that encourages a therapeutic relationship to develop and allows patients to feel comfortable doing some deep self-reflection. Patients will be monitored for responses to medications and treatment and adjustments will be made if necessary.
If you or someone you love is considering residential mental health treatment, please call our admissions specialists at 888-534-2295. All calls are confidential. Contact us today and we can help you start your journey to a more fulfilling life than you ever thought possible.