Mental health and the BioPsychoSocial model

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The diagnostic process in mental health is key to understanding a person’s signs and symptoms, allowing the clinician to diagnose the patient with a syndrome. This is important as it allows clinicians to prescribe appropriate treatment along with better quality of care for recovery.   
The recognition and diagnosis of mental health disorders go as far back as Greek medicine, where Hippocrates developed the humoral theory around 400 BC. Hippocrates believed that four different substances were responsible for the range of human emotions and behaviours. Subsequently an imbalance of these substances or humours resulted in poor mental health such as melancholy, hysteria and phobia. The diagnosis of mental illness then revolved around identifying the humoral disparity and prescribing correct treatment to re-balance the humours (Martins-Mourao, 2013). Moving on to the mid-18th century, medicine took a new perspective on illness with the interest in dissection and the use of microscopes. Medicine started to focus largely on the disease process of illness. This resulted in the biomedical model and a new pathological paradigm to explain the causes of disease. Emil Kraepelin a German psychiatrist around that time, argued that mental disorders should be approached using the same taxonomy as physical illnesses. Which allowed Emil to re-define diagnostic categories, enabling predictions for the course of a mental illness (Martins-Mourao, 2013). This new biomedical approach to illness and disease was a substantial breakthrough, making medicine what it is today, but unfortunately lost the whole person approach within the diagnosis and treatment process.  

Today the diagnostic process for mental health consists of a range of assessments. A case formulation takes all the gathered information from biological, psychological, and social aspects and allows the clinician to build up a picture of the individuals condition (Martins-Mourao, 2013). To build a case formulation a psychological assessment is typically carried out to allow the clinician to build a database of the patient. This process first involves a clinical interview where the clinician will have a structured conversation with the patient to gather relevant information about the person’s symptoms, clinical history and general life. Then, the clinician will investigate the signs and symptoms along with appropriate psychological testing, such as psychometric tests and neuroimaging. The clinician will then discriminate between possible disorders from symptoms presented and the information gathered with a differential diagnosis. They will also assess if there is any comorbidity, that is more than one syndrome present. Finally, all the information gathered throughout the assessments will be Put together to form a case formulation. This allows an organised theory to be developed integrating the biological, psychological, and social factors that could be implementing the individual’s symptoms and mental state, and will be used to guide treatment (Martins-Mourao, 2013).  
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A case formulation is a useful tool for understanding the factors that are causing an individual’s mental illness. It helps the clinician organise the information gathered about the individual and highlight’s any influencing factors (Martins-Mourao, 2013). Its moving away from the reductionist biomedical approach and taking a holistic biopsychosocial perspective. This is more advantageous when diagnosing and planning treatment as it is taking a whole person approach. Although a biological explanation of illness has advantages, such as aiding the clinician in diagnosis and giving the knowledge of disturbed brain processes, it doesn’t take in to account other external factors that can affect a person’s mental state. For example, a longitudinal study by Harvard researchers (Peterson et al., 1988) found that a person’s explanatory style of unfortunate events can affect mental health. That is, someone with a pessimistic view will see events out of their control and thus have a negative impact on their thoughts and feelings. This shows how someone’s psychological reactions play a part in their mental health. So, when hypothesising the causes of a mental illness it’s important to take in to account all individual factors, which is precisely what a case formulation should achieve.  
As mentioned, diagnosing a mental illness is important as it allows the clinician to give appropriate treatment and quality care for the patient’s recovery. However, a diagnosis is not straight forward and distinguishing the normal from the abnormal faces limitations. The DSM is the most used diagnostic system in the UK. This system classifies nearly 300 diagnostic categories, but its reliability is questionable. Firstly, there are arguments claiming the DSM’s artificial creation of disorders. In 1952 there was 106 categories, compared to 2000 with 297 categories. This is because understanding of disorders has evolved and as societal norms change new disorders are being identified. Secondly, there are issues with clarity, as some disorders can be difficult to differentiate between with the DSM’s diagnostic categories. For example, someone displaying signs of BPD will be a lot harder to identify than someone with OCD (Martins-Mourao, 2013). However, the DSM is constantly being improved and updated for these reasons. Finally, with a diagnosis comes a label. This can make the individual feel branded after receiving a diagnosis. In addition, society may view people with some stigmatism knowing they have a mental illness, which can could lead to discrimination issues.
It is clear that a mental disorder is much more than a biological phenomenon, and a person’s psychological and social factors play a big part in the illness. For this reason, it’s important to integrate a biopsychosocial approach in diagnosis and treatment. We have come a long way from the historical roots of biomedical diagnosis in mental health, to today where case formulations are used to help clinicians hypothesise about an individual’s case. However, there are still many limitations in diagnosing, illustrating the importance of taking in to account all biological, psychological and social factors with a biopsychosocial approach to improve mental health treatment and recovery.  
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Reference list  
Martins-Mourao, A. (2013) ‘Diagnosing mental illness’, in Martins-Mourao, A. and Toates, F. (eds) Core concepts in Mental Health, Milton Keynes, The Open University, pp. 91-137. 
Toates, F. (2013) ‘Understanding mental health and ill health’, in Martins-Mourao, A. and Toates, F.   (eds) Core concepts in Mental Health, Milton Keynes, The Open University, pp. 1-27. 
Toates, F. (2013) ‘Factors that contribute to mental well-being’, in Martins-Mourao, A. and Toates, F.  (eds) Core concepts in Mental Health, Milton Keynes, The Open University, pp. 63-90. 

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