Mental Health Clinicians’ Perceptions of the diagnosis of Bipolar Disorder: A Q-study

This thesis was written to fulfil the requirements of the University’s Doctorate in Clinical Psychology. The thesis is made up of three sections: a review of the research literature focused on service users’ experience of psychiatric diagnosis, an empirical paper exploring clinicians’ perceptions of the diagnosis of Bipolar Disorder and an executive summary outlining the study designed for dissemination in clinical practice.
The literature review identified four important aspects of mental health diagnosis for service users: whether service users wanted to be told about their diagnosis, the communication of the diagnosis, positive aspects of being given a psychiatric diagnosis and disadvantages of receiving a psychiatric diagnosis. Accuracy, timing and communication of diagnostic feedback were all thought to be important for service users receiving a mental health diagnosis, whilst fostering hope was paramount in positive experiences. The review concluded that service users held a wide variety of different perceptions of psychiatric diagnosis and recommended that clinicians were offered specific training on feeding back a mental health diagnosis to service users.
The empirical paper used Q-methodology to explore the subjective viewpoints of mental health clinicians on the diagnosis of Bipolar Disorder. This study noted the mixed literature on the use of the diagnostic label in mental health services and aimed to explore whether clinical practice mirrored the previous research. A total of 19 mental health clinicians completed Q-sorts in which they were asked to rank statements about the diagnostic label of Bipolar Disorder. Three main factors emerged: (1) Seeing the person and their experience, (2) Promoting quality through standardised processes and (3) Understanding the function of diagnostic labels. All three factors agreed that sufficient time should be taken to assess for Bipolar Disorder and that communication using purely the diagnostic label was not helpful. Holding different perspectives on the diagnosis of Bipolar Disorder is likely to make it difficult to provide consistent, high-quality care for service users and it was suggested that services may benefit from better integration of these viewpoints moving forward. The executive summary outlines an overview of the empirical paper that can be disseminated to mental health services.