A diagnosis is not the same as care
In physical medicine a diagnosis is a tool. Suppose you have diabetes: the diagnosis gives direct information about your blood sugar, your risk of complications and the kind of care you need. You get lifestyle advice, insulin or other medication, and regular checks. The diagnosis leads to a clear care pathway.
In psychiatry it works very differently. A diagnosis says almost nothing about the concrete help someone needs. One person with a given diagnosis benefits from rest, structure and creative expression, another from trauma therapy, family conversations or a social network. One person with a bipolar susceptibility lives well without medication, another needs intensive guidance.
What you do need: a view of care needs
Care needs are about the question: what do you, as a unique person, need to get your life back on track? That is not about labels, but about support in areas such as:
- Housing and safety
- Work or daytime activities
- Relationships and connection
- Physical health
- Meaning
- Coping with emotions and stress
- Information and psychoeducation
- Practical support
The Camberwell Assessment of Need is an instrument that addresses exactly this. It looks at what people need in all kinds of areas of life, and distinguishes between what someone already gets and what is still missing. That information is much more useful for care than a DSM diagnosis.
Transdiagnostic thinking: beyond the boxes
More and more researchers and practitioners argue for a transdiagnostic approach. That means looking at needs, susceptibilities and strengths that do not depend on one specific diagnosis. Much mental distress cannot be neatly divided into separate boxes, and many requests for help occur across different diagnoses. Think of loneliness, trauma, sleep problems, questions of identity, anxiety, overstimulation, a crisis of meaning.
If you look transdiagnostically as a care provider, you focus on ‘what someone goes through and needs’ and not on naming ‘what someone has’. In this way you prevent medicalisation, overdiagnosis and endless labelling without a plan.
Why all that diagnostics then?
Mental health care is often organised in such a way that you need a diagnosis to get care. Without a label there is no access and no funding. And so a lot of money and time goes into diagnostics, even though it often yields little for the person. A personality assessment of 12 sessions? Good for the report, but seldom leading for the treatment.
Imagine that we put that energy into really mapping care needs well. Not: “You have borderline features and a raised score on scale X.” But: “You are looking for stability, safe relationships, acknowledgement of trauma, and help in dealing with inner chaos.” That is the language of recovery, of connection, of humanity.
Time for a reversal
Let us stop with the illusion that a diagnosis gives clarity, and focus more on care needs. Let us listen to people, their context, their struggle and their strength. Let us begin, as standard, with the question: what do you need now? And tune our care to that. Because nobody recovers from a label. People do recover from acknowledgement, support and meaningful help.
Read more: Schizophrenia spectrum versus psychosis spectrum.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare.
Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. In 2026 he published 'Wat psychisch lijden is'.
Want to read more?
Blogs by Jim van Os can be read here
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