Clinicians’ perceptions of the Bipolar Disorder diagnosis: a Q-study

DOIhttps://doi.org/10.1108/JMHTEP-08-2018-0045
Pages1-12
Date02 December 2019
Published date02 December 2019
AuthorRachel Wakelin,Peter Oakes
Subject MatterHealth & social care,Mental health,Mental health education
Cliniciansperceptions of the Bipolar
Disorder diagnosis: a Q-study
Rachel Wakelin and Peter Oakes
Abstract
Purpose Research indicates that the diagnostic label of Bipolar Disorder is being both over and
under-used in mental health services. Disagreement between clinicians in how the diagnosis of Bipolar
Disorder is perceived and how the label is used can make it difficult to establish and uphold consistent care.
This may lead to the expe rience of negative emoti ons for service users and poor engagement with
intervention. There fore, the purpose of this pa per is to explore whether clinicians do hol d different
perceptions of the diagnosis of Bipolar Disorder, with the view of providing insight into how thismay impact
service provision.
Design/methodology/approach Q-methodology was used to investigate the subjective viewpoints of
19 clinicians from mental health community teams supporting individuals with a diagnosis of Bipolar Disorder.
The completed Q-sorts were subject to analysis using Q-methodology analysis software.
Findings Three main factors representing the viewpoints of participants were identified: seeing the person
and their experience, promoting quality through standardised processes and understanding the function of
diagnostic labels. All three factors agreed that more than one assessment appointment should be required
before a diagnosis of Bipolar Disorder was given and that the focus should be on the difficulties experienced
rather than the diagnostic label.
Originality/value These three viewpoints provide different perspectives of the diagnosis of Bipolar
Disorder, which are likely to impact on service provision. Services may benefit from a better integration of the
viewpoints, noting the important functions of each viewpoint and being guided by individualsneeds.
Keywords Mental health, Diagnosis, Clinician, Q-methodology, Bipolar Disorder, Diagnostic criteria
Paper type Research paper
Introduction
Diagnosis is widely used in mental health services to dictate service structure, referral protocol
and intervention processes. Despite this, there is a lot of disagreement between clinicians about
whether diagnosis should be used to understand mental health difficulties. Medical models of
mental health advocate that psychiatric difficulties result from a disease or abnormality of the
brain (Andreasen, 1985), promote the use of discrete diagnostic criteria and prescribe
medication in a similar way to physical health (Freeth, 1997). Amongst other things, the
medicalisation of mental health offers structure to services by determining care pathwaysthat
ensure service users receive appropriate support for their difficulties and offers a legitimate name
for experiences (Angermeyer and Matschinger, 2003).
Some disagree with using medical style diagnosis in mental health, suggesting that it medicalises
ordinary responses to traumatic life events (Illich, 2001), leads to increased stigma (Hinshaw, 2007),
and fails to acknowledge theimportance of early lifeexperiences, relationships and attachments in
the development of difficult or unhelpful behaviours (Engel, 1977). Understanding mental health
difficulties from a psychological perspective acknowledges the influence of an individualslearning
on their experience, as well as considering the roles that cognitive a nd relational development can
have on emotion regulation (Kinderman, 2005). Furthermore, psychological approaches aim to
empower service users through developing a shared understanding of the mechanisms underlying
difficulties ( Johnstone, 2008). However, contextual factors can prove to be a barrier to change
Received 6 August 2018
Revised 10 October 2019
Accepted 10 October 2019
Rachel Wakelin and Peter
Oakes are both based at the
School of Life Sciences and
Education, Staffordshire
University, Stoke-on-Trent, UK.
DOI 10.1108/JMHTEP-08-2018-0045 VOL. 15 NO. 1 2020, pp.1-12, © Emerald Publishing Limited, ISSN 1755-6228
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
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