Making a good mental health diagnosis: Science, art and ethics

There are limitations to psychiatric classification, which affects the utility of diagnosis in general practice.

The aim of this article is to explore the principles of science, art and ethics to create clinically useful psychiatric diagnoses in general practice.

Psychiatric classification systems provide useful constructs for clinical practice and research. Evidence-based treatments are based on the classification of mental illnesses. However, while classification is necessary, it is not sufficient to provide a full understanding of 'what is going on'. A good psychiatric diagnosis will also include a formulation, which provides an understanding of the psychosocial factors that provide a context for illness. Experiences such as trauma and marginalisation will change the illness experience but also provide other forms of evidence that shape therapy. Diagnoses also carry ethical implications, including stigma and changes in self‑concept. The science, art and ethics of diagnosis need to be integrated to provide a complete assessment.