What is a Mental Health Diagnosis?
A mental health diagnosis reflects a clinically significant behavioral or psychological syndrome or pattern
that occurs in an individual and that is associated with present distress or disability or with a significantly
increased risk of suffering death, pain, disability or an important loss of freedom. It is a manifestation
of a behavioral, psychological, or biological dysfunction in the individual. Similar to physical health
diagnoses, with a mental health diagnosis there may be core, defining symptoms and then typical
symptoms that are present for the majority of individuals. Mental health diagnoses are currently based
on the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision or DSM-IVTR. Discussion has already begun on the next edition which should be released shortly.
In DSM-IV-TR, like in previous editions, explicit diagnostic criteria are provided and it is based on a multiaxial system. DSM-IV-TR does not typically denote a specific etiology or cause for each disorder. Each
disorder does require a specific functional impact on the individual including impact in the area of social,
academic or occupational functioning. This impact is captured on Axis V with the Global Assessment of
Functioning Scale. This scale is divided into 10 ranges of which address the severity of the symptoms
and impact on functioning. The scale runs from 0 to 100 with 0-10 indicating “persistent danger of
severely hurting self or others or persistent inability to maintain personal hygiene or serious suicidal act
with clear expectation of death”. A rating of 91-100 reflecting “superior functioning in a wide range of
activities, life’s problems never to get out of hand, is sought out by others because of his or her many
positive qualities”.
The multi-axial system addresses identifies different domain of information that may help in treatment
planning and identifying the likely course or outcome. The fives axes are:
Axis I- Clinical Disorders and Other Conditions that May be a Focus of Clinical Attention
Axis II – Personality Disorders and Mental Retardation
AxisIII_ General Medical Conditions
Axis IV: Psychosocial and Environmental Problems
Axis V: Global Assessment of Functioning
A mental health diagnosis is provided to guide treatment, whether it is a behavioral intervention,
therapy or psychotropic medications. For example a child with Attention Deficit Hyperactivity Disorder
may be placed on a stimulant medication. However a child with an affective or depressive disorder
another form of medication may be tried along with cognitive-behavior therapy. The diagnosis also can
summarize what typical symptoms may be manifested. In our example, the child with ADHD may be
inattentive and impulsive leading to problems at school. The youth with a mood disorder may feel sad
or irritable, their sleep and appetite might be affected and there may be a suicide risk.
Although a mental health disorder has an impact on the individual’s functioning, that impact can be in
one (or more) life domains. An educational diagnosis must have an impact specifically on the youth’s
academic functioning or ability to learn. A mental health disorder may or may not impact the youth’s
academic performance. A child with ADHD may benefit from a trial on a stimulant medication, so
requires mental health treatment. If the disorder does not impact their ability to learn they may not
qualify for an educational diagnosis or for 504 or special educations services. The term serious
emotional disorder/disturbance is used both in the field of mental health as well as the educational
field. Again to qualify as an educational diagnosis there has to be a significant impact on learning. In the
mental health field learning is just one area that may be impacted by a mental health diagnosis.
There are a number of mental health diagnoses that are specifically characterized by academic
performance and are often identified as developmental disorders or learning disorders. The impact on
academic functioning is typically specific such as in a Reading, Mathematics, or Written Language
Disorder. Other disorders that are classified as developmental disorders typically impact academic
functioning due to sub-average intellectual functioning such as mental retardation.
Both mental health and educational diagnoses are a short hand way to describe a cluster of symptoms
that impact an area of functioning; both may help guide initial interventions to alleviate the symptoms
or the impact of the symptoms. However a mental health diagnosis does not automatically equate to an
education diagnosis and vice versa. For children and youth who have a mental health diagnosis, parents
and professionals should monitor the impact on the child’s academic performance, and if necessary
have the child evaluated to determine if they are eligible for an educational diagnosis and special
education services. A child with an educational diagnosis may or may not need mental health supports
and services. However again these children should be monitored as learning disorders often co-occur
with mental health disorders.