Implications of DSM-5 for Health Care Organizations and Mental Health Policy

By Castillo, Richard J.; Guo, Kristina L. | Journal of Health and Human Services Administration, Fall 2016 | Go to article overview

Implications of DSM-5 for Health Care Organizations and Mental Health Policy


Castillo, Richard J., Guo, Kristina L., Journal of Health and Human Services Administration


ABSTRACT

The American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, and has far reaching implications for health care organizations and mental health policy. This paper reviews the four new principles in DSM-5: 1) A spectrum (also called "dimensional") approach to the definition of mental illness; 2) recognition of the role played by environmental risk factors related to stress and trauma in predisposing, precipitating, and perpetuating mental illness; 3) cultural relativism in diagnosis and treatment of mental illness; and 4) recognizing the adverse effects of psychiatric medications on patients. Each of these four principles will be addressed in detail. In addition, four major implications for health care organizations and mental health policy are identified as: 1) prevention; 2) client-centered psychiatry; 3) mental health workers retraining; and 4) medical insurance reform. We conclude that DSM-5's new approach to diagnosis and treatment of mental illness will have profound implications for health care organizations and mental health policy, indicating a greater emphasis on prevention and cure rather than long-term management of symptoms.

INTRODUCTION

In recent years the field of psychiatry has received blistering criticisms for the overuse of psychoactive drugs for the treatment of the mentally ill that sometimes have devastating side effects, as well as widespread conflicts of interest for psychiatrists in mental health research and clinical practice, and the pervasive influence that drug manufacturers have over the entire field (e.g., Angell, 2011a,b; Carlat, 2010; Kirsch, 2010, Whitaker, 2010). Cognizant of these criticisms, the American Psychiatric Association (APA) has made major changes in the way mental illness is conceptualized, assessed, and diagnosed in its new diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, that has far reaching implications for health care organizations and mental health policy.

Starting in the 1950s and 1960s, with the introduction of lithium and neuroleptic medications, biologically oriented psychiatrists were advocating a move toward the medical model of mental illness. This movement culminated with the publication of DSM-III (APA, 1980). According to Robert Spitzer, chairman of the DSM-III Task Fore that authored the manual, DSM-III was intended to be a "defense of the medical model as applied to psychiatric problems" (Wilson, 1993). Based on the acceptance of the medical model of mental illness, a huge infrastructure of health organizations including drug companies, insurance companies, government agencies, medical schools, hospitals, clinics, mental health providers and case managers was created in the United States that was designed to manage the symptoms of mental illness with medications, rather than cure mental patients of their illnesses (Whitaker, 2002, 2010). However, in recent decades, this mental health policy based on the medical model has been associated with a doubling of mental health disability that can rightfully be conceptualized as a startling epidemic of mental illness (Whitaker, 2010).

The medical model of mental illness codified in DSM-III (APA, 1980) arose primarily because of the limited success obtained from treating patients with psychoactive medications that altered neurotransmitters in the brain. This led to the theory that various mental disorders were discrete brain diseases caused by chemical imbalances of genetic origin. There was no existing proof that each of the hundreds of disorders in DSM-III was based in a separate chemical imbalance. It was simply assumed that each of the disorders could first be defined along a pattern of symptoms. …

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