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[Image: Getty/iStock].

The link between disability benefit assessments, mental health problems and increases in suicide rates could be made explicit in a new plan announced in medical journal The Lancet.

Kate Allsopp and Peter Kinderman have called for mental health professionals to record psychosocial codes in official NHS records, to show whether a patient is suffering from the effects of social inequality, poverty or trauma.

Links between the Work Capability Assessment (WCA) and an increase in suicides, mental health problems, and prescription of antidepressants are specifically mentioned, following on from a study covered by This Site here.

The proposal in The Lancet states [boldings mine]:

It is well known that poverty and social inequity are major determinants of our mental health, and the United Nations Special Rapporteur characterises mental health care not as a crisis of individual conditions, but as a crisis of social obstacles, which hinders individual rights.

It is important, therefore, that the circumstances that have given rise to distress should be formally recorded alongside the distress itself. Psychosocial codes… incorporate descriptive information regarding adverse life experiences and living environments, but are almost never used or reported in clinical practice or academic publications.

These quasi-diagnostic codes document neglect, abandonment, and other maltreatment… homelessness, poverty, discrimination, and negative life events in childhood, including trauma… problems related to family upbringing, and housing and economic problems.

Broadening routine data capture within UK National Health Service records could establish more inclusive, social, systemic, and psychologically comprehensive patterns of difficulties, which could target information regarding established social determinants of mental health problems, such as inequality, poverty, and trauma.

Imagine if it were as serious to fail to document extreme poverty as it would be for a clinician to fail to identify severe depression.

We do not expect that clinicians should resolve such difficulties; it is not the job of mental health professionals to end poverty.

Nevertheless, proper recording of psychosocial… codes in the context of psychiatric diagnoses is imperative because of the close relationship between the two.

The UK government programme of reassessing disability benefits… using the Work Capability Assessment has been associated with an increase in suicides, mental health problems, and prescription of antidepressants.

Transitions into poverty (relevant to codes [on] inadequate housing… lack of adequate food… extreme poverty; and… low income) have been associated with increased odds of children developing socioemotional behavioural difficulties, and individuals who have had an institutional upbringing… are approximately 11 times more likely to experience paranoia compared with those with a less disrupted early history.

As clinicians, we might be better able to serve our clients if we can use such data capture to apply more effective pressure on the political system and drive wider system reform.

Source: A proposal to introduce formal recording of psychosocial adversities associated with mental health using ICD-10 codes – The Lancet Psychiatry

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