Psychologists and psychiatrists are trained in recognising symptoms that fit within the DSM-classification (a classification system used by mental health professionals to diagnose mental disorders). There are lengthy lists of questions, IQ-Tests, personality profiles, neurological studies – and at the end there’s a label: depression, psychosis, borderline, ASS, ADHD, bipolar…

But what precisely is the use in that?

Diagnosing a patient is not the same as caring for that patient In somatic health care, a diagnosis is just a tool. Imagine being diabetic: then your diagnosis is an exact reflection of your blood sugar levels, the risks, the complications, and the type of care you need. You’ll get advice on your lifestyle, insulin, other medication, and regular checks. The diagnosis leads to a clear care plan.

In the psychiatric field, it doesn’t work like that. A diagnosis like schizophrenia doesn’t say anything about the type of care someone needs. One person with this diagnosis may need rest, structure, and creative expression, whilst another may need trauma therapy, family sessions, or a social network. One person with vulnerability to psychosis may be able to live without medication, whilst another needs intensive guidance.

What you do need: a focus on care needs

Healthcare needs are the answer to the question: What do you, a unique person, need to get your life back on track. This is not about labels, but about support with things like:

• Living and safety
• Work or daily schedule
• Relationships and connectedness
• Physical health
• Purpose
• Coping with emotions and stress
• Information and psycho-education
• Practical support

The Camberwell Assessment of Need is a tool that does exactly that. It looks at what people need in all areas of life, and distinguishes between what people are already getting and what they still require. That information is much more useful than a DSM-classification.

Care needs and transdiagnostic thinking: further than labels

More and more researchers and practitioners call for a transdiagnostic approach. That means: looking at the needs, vulnerabilities and strengths that don’t depend on one diagnosis. Psychological suffering is often difficult to distinguish, and many questions may arise with a diagnosis. Think about loneliness, trauma, difficulty sleeping, questions about personality, anxiety, overstimulation, finding purpose – they all go beyond a diagnosis.

If your physician has a transdiagnostic approach, he won’t focus on ‘what someone has’ but on ‘what someone experiences and needs’. This way they’ll prevent medicalisation, excessive diagnosing, and endless labelling without a treatment plan.

So why do we focus so much on diagnostics?

In the Dutch mental healthcare sector you need a diagnosis to get treatment. No label, no care. So a lot of time and money is being put into diagnostics – even though it doesn’t do much for the patient. A 12-session personality research? Nice for the end report, but seldom leads to treatment.

Imagine we put all that energy into actually identifying someone’s medical needs. Not: ‘You have borderline symptoms and heightened score on the scare of X’. But: ‘You require stability, safe relationships, acknowledgement of trauma, and help with handling your inner turmoil’.

That is the language of recovery, connection, and humanity.

Care needs: Time for reversal

Let’s give up the illusion that a diagnosis gives clarity, and focus more on someone’s needs. Let’s start listening to people, their context, their struggle, and their strength.. Let’s start with the question: What do you need at this moment? And adjust our care plan accordingly.

Because nobody recovers by being labelled. But by getting acknowledgment, support, and meaningful help.

translated fromDutch by SGM Taplin