Allsopp Kate, Kinderman Peter
Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK.
J Ment Health. 2021 Feb;30(1):97-103. doi: 10.1080/09638237.2019.1677875. Epub 2019 Oct 24.
Diagnoses are controversial but ubiquitous in mental health; however, whether they are essential features of service entry has not been analysed.
To investigate the use of diagnosis in the service entry criteria of UK NHS adult mental health services.
Freedom of Information requests were made to 17 NHS adult mental health Trusts; responses were analysed thematically.
Four service types were identified: broadly diagnostic, problem-specific, supporting specific life circumstances and needs-led. Diagnoses were used frequently but not universally. Non-diagnostic factors were central to service entry criteria.
Diagnoses were neither necessary nor sufficient in-service entry criteria. Broad clusters of difficulties were used rather than specific diagnoses. Extensive exceptions revealed diagnoses as inefficient proxies for risk, severity and need. Differences across criteria appeared largely driven by professional competencies. Implications for innovative care pathways include preventative services and working with psychosocial factors.
诊断在心理健康领域存在争议但却普遍存在；然而，它们是否是服务准入的基本特征尚未得到分析。
调查诊断在英国国民健康服务体系（NHS）成人心理健康服务的服务准入标准中的使用情况。
向17个NHS成人心理健康信托机构提出信息自由申请；对回复进行主题分析。
确定了四种服务类型：广泛诊断型、问题特定型、支持特定生活状况型和需求导向型。诊断被频繁使用但并非普遍使用。非诊断因素是服务准入标准的核心。
诊断在服务准入标准中既非必要条件也非充分条件。使用的是广泛的困难类别而非具体诊断。大量例外情况表明，诊断作为风险、严重程度和需求的代理指标效率低下。标准之间的差异似乎很大程度上是由专业能力驱动的。对创新护理途径的启示包括预防性服务以及应对心理社会因素。
