DSM5 in Distress

The DSM's impact on mental health practice and research

Mental Health Clinicians Can Use ICD-10-CM

Warning to DSM 5

I just read a blog by Dr. Dayle Jones that could have an important influence in the endgame effort to save DSM 5 from itself. See it at http://my.counseling.org/2011/08/16/what-should-counselors-do-abo...

Dr Jones is chair of the American Counselors Association's (ACA) "DSM 5 Proposed Revisions Task Force,". She has studied the DSM 5 proposals carefully and has developed serious concerns about the many risky new diagnoses, lowered thresholds for old ones, untested scales, and lack of serious scientific review.

Dr Jones has now found a solution for those who will remain disturbed by the ultimate DSM 5 product- simply don't use it. She indicates how clinicians could easily bypass a flawed DSM 5 by instead downloading ICD-10-CM codes. These will become official shortly after DSM 5 is published and are available for free online. Dr Jones' suggestion should send a powerful warning to the American Psychiatric Association (APA). If DSM 5 does not quickly reform its processes and products, many mental health professionals may decide not to use it.

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Here's a quote from Dr. Jones' blog:

"With over 500,000 mental health professionals in the U.S. that use the manual (197,000 social workers; 115,000 mental health counselors; 54,000 marriage & family therapists; 93,000 psychologists; 75,000 psychiatric nurses; 38,000 psychiatrists), the DSM greatly impacts counselors' work in assessing, diagnosing, and treating clients.
In fact, the American Psychiatric Association (APA) is the sole group that revises the DSM, despite representing only 7% of all mental health professions.

For years, counselors and other mental health professionals have relied on APA and the DSM for guidance in the diagnosis process. Yet, the DSM-5's questionable research methodology leaves me wondering if we should continue.

I've recently been writing about the International Classification of Diseases (ICD-10-CM). My purpose has been to educate counselors that DSM is not mandatory for most clinicians unless specifically required by their institutional settings. In fact, the ICD is the only classification system approved by HIPAA - not the DSM. As such, ICD codes meet all insurer-mandated and HIPAA coding requirements.

The reason why mental health professionals can use the DSM-IV for diagnosis is because the DSM derives its code numbers from the ICD.
Currently, the DSM-IV code numbers reflect the ICD-9-CM codes. However, the DSM-5 codes will have to reflect those from the ICD-10-CM because use of the ICD-10-CM becomes mandatory by all health professionals in October 2013.

I've been publicizing the use of ICD as an alternative to DSM so that counselors know they are not confined to using the DSM-5 - especially if they find that the DSM-5 lacks credibility. And, to use ICD-10-CM, counselors
do not have to learn a whole new classification system. In fact, counselors can continue to use their DSM-IV and simply look up and use the new ICD-10-CM codes numbers (available free online).

Personally, I want the DSM-5 to be a quality product that I can trust for diagnosis. I've used the DSM during my entire career as a counselor, and I feel some allegiance to this classification system. But the inclusion of potentially dangerous, scientifically unfounded diagnoses scares me enough to possibly abandon the DSM."

Enough said. American Psychiatric Association take note.

 

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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