Idle thoughts on ICD-10

Ive just completed a set of training days on mental health awareness for a Housing Association whose target group are homeless people in the North East of England. I know the organisation well and we have worked together on a number of projects over the years.

This has been the first time Ive provided overview introductory training on Mental Health. The training was enjoyable and well received ...but it was the nature of the discussions with people who have no background in mental health or therapy that set me thinking.....

ICD-10 is predominant now as THE organising structure for psychoogical problems and psychotherapy in the UK. It is the primary classification system used by the primary funders of any service - the government or insuarnce companies, and influences the theoretical and linguistic framework in which other service providers think.

ICD diagnostic classification determines whether someone has a psychological problem and who shoukld be addressing it. It assumes a number of things ranging from the the unspoken belief that psychological difficulties relate to questions of "health" through importance of differential diagnosis to an assumption of treatment cure. I'm sure we all have an opinions on this way of thinking. However....this is not what my idle thoughts are about.

What has struck me regarding my recent involvement however is how much this sytem does NOT apply or doesnt WORK for practically all of the clients this organisation is dealing with.

Firstly, arounf fifty percent of their clients have psychological problems that dont fit into ICD-10 - anger problems, general lack of motivation or interest in life (without the necessary additional features to fulfill a diagnosis of depression), general "oddness" which psychaitrists have told them they shouldnt worry about etc....except for the fact that these presentations are a cause of distress for either the clients themselves or those around them.

Secondly, a large proportion of their clients have the dreaded P.D. diagnosis which is of course the 21st century equivalent of leprosy as far as mental; health services are concerned. Despite statements from NICE on the importance of mental health services addressing P.D. needs it still remains a primary reason for many of such services tio say that it is not their business to address their needs.

Finally, about 80% of their client have dual diagnostic problems....most commonly substance misuse and psychological problems, but occasionally learning disabilities and mental health problems....and as we all know dual diagnosis brings out the worst in a jobs worth attitude in statutory services, leading to an unending merry-go-round of trying to find someone who will meet the needs of such clients.

The long and the short of it is that some of the neediest people in out society get a really lousy service for their psychological problems or don't get any service at all ! And I'm convinced that a system that has made ICD-10 SO parameount is to blame....A system based on symptoms interfering with functioing or percived indivual need or distress seems a much more logical and equitable system to base our thinking on.....

All Ive got to do now is convince the medical professiona s a whole, the pharmaceutical industry and the cuurent holders of service and research budgets....Shucks....Im sure that wont be TOO difficult :o)

Paul Grantham
Consultant Clinical Psychologist