A simple, but excellent, letter

I would just like to share this letter I received yesterday.

It really doesn’t much commentary (I've put just one section in bold... and, yes, I have got permission!)

Dear Peter

I wonder if it would be possible for staff to simply stop giving people diagnoses.

I temped for [a local] Community Mental Health Team at [a local hospital Trust], and used to take minutes for the team meeting. The psychiatrist’s secretary said to me when we were getting the files out for new patients, that if it was an old file, the patients often did not have a diagnosis because in the past, it had not been necessary but the Department of Health now said that everyone had to have a label given to them – is it in order to prescribe medications? Not sure – and so old patients would now have a diagnosis given to them and this would have to be updated on their Care Notes record. I did observe the psychiatrist pondering over what number to give to a patient and kind of with resignation, picking a number. From what people said, they felt it was a bit arbitrary and lots of people say that their diagnosis keeps changing. Then when they get better, they are in remission from the last diagnosis they had but presumably not from all the previous diagnoses they had.

So I was wondering, could the Deparment of Health be encouraged to row back from this. I don’t have to rehearse the arguments for this here. You know them very well. That mental health diagnoses are like star signs. I could not agree more. It’s not about a publicity campaign to make them acceptable or to reduce stigma. It is about giving someone a label at all. Maybe you could have a tick box of behaviours that the person shows at one time.

That needs thinking about and I am sure that your colleagues have thought about this already and perhaps have thought of a good alternative.

It is a bit like a meal: you have carrots and potatoes and leeks and you end up with vichyssoise. But if you change the balance or what you do with the ingredients, you could have roast vegetables or a curry. It is the proportion and whether they behaviours are balanced out by other behaviours. But a loaf of bread made by one person on one day unless it is made in a bread-making machine, is unlikely to be exactly the same if they make it on a different day or if a different person makes a loaf of bread.

Even if someone breaks a bone, they break it in a different way and in a different place from someone else. There is not just one way that a leg is broken.

A broken leg is not “in remission” if it is mended. A headache or flu is not “in remission” if they go away or clears up. Maybe mental health has more in common with the common cold – you develop new defences, a cold is not “in remission”.

Susanna