New diagnosis could confuse mental health care

ELEANOR HALL: There's renewed debate over the clinical definition of depression and whether it should be extended to encompass the most severe symptoms of grief.

Mental health experts in the United States are considering bundling depression and bereavement together in the new diagnostic manual of mental disorders.

Experts here in Australia are warning that could medicalise normal human emotions as Emily Bourke reports.

EMILY BOURKE: To some the symptoms are the same but in the medical world grief and depression are regarded as very different beasts - but that might be about to change.

The American Psychiatric Association is updating its classification system known as the Diagnostic and Statistical Manual of Mental Disorders, or DSM.

Dr Allen Frances from Duke University says it's been proposed that grief and loss be considered as something much more severe.

ALLAN FRANCES: Feelings of sadness, loss of interest, loss of energy, loss of appetite, difficulty sleeping and this lasted for up to two months after losing a loved one, well that would be natural. In the new system that is being suggested after two weeks of these symptoms you get a diagnosis of major depressive disorder.

EMILY BOURKE: The idea has divided the medical profession in the United States and mental health experts here are wary.

Frank Quinlan is from the Mental Health Council of Australia.

FRANK QUINLAN: Something like 20 per cent of the population in Australia will experience some form of depression at some point in their lives. The vast majority of those people won't experience any assistance at all so it is really important that people seek help. We don't want to see all of these problems lumped into one basket. Just because somebody has a diagnosis of depression, it doesn't necessarily mean they need medication. It doesn't necessarily mean that their life is going to be completely turned upside down.

IAN HICKIE: I think the trouble is it threatens to undermine the wider credibility of clinical psychiatry when we just confuse a whole lot of different states that we already have good understanding of how to approach those disorders and provide appropriate support.

EMILY BOURKE: Professor Ian Hickie is from the Brain and Mind Institute at Sydney University.

He says even though grief can evolve into depression, changing the definitions could be a step backwards.

IAN HICKIE: Some people who have experienced a loss may go on to develop something that is more akin to a depressive illness over time and much more importantly, might become actively suicidal or might be likely to benefit from specific psychological care. And on one level I think that is what it is trying to address.

I think however at the wider level people will see it as a nonsense to mix up understandable normal mood states which are best supported by family and support and normal mechanisms from those that require any specific professional intervention.

EMILY BOURKE: He also points to differences between the American and Australian health systems when it comes to mental health care.

IAN HICKIE: In the United States what tends to happen is the applying of medical labels to a whole range of psychological states in order that you can get health care. We don't have that problem in Australia and in most other health systems.

Another characteristic of the United States is that wider use of medicines in a number of situations than elsewhere in the world and importantly in Australia with changes in the Medicare system, we now see greater access to psychological therapies which is a really good thing.

So nobody in the Australian setting will be rushing to prescribe medicines inappropriately to people who are in the middle of an acute grief state but there are situations where people are suicidal, where people are on their own, where people are developing major sets of problems where provision of appropriate psychological care may well be the best way to deal with that situation.

And that would have happened using a normal grief label, it will happen in the future and I think common sense will prevail in Australia no matter what route the Americans choose to go down.

EMILY BOURKE: The DSM5 will be published next year.

ELEANOR HALL: Emily Bourke with that report.