MHA Code of Practice interpretation of para 14.75

Cut and copy from MHA Code of Practice.

14.75 Doctors must give reasons for the opinions stated in their recommendations. When giving a clinical description of the patient’s mental disorder as part of these reasons, doctors should include a description of the patient’s symptoms and behaviour, not merely a diagnostic classification.

During discussion of a section 2 topic previously there was a comment that there was no requirement for a diagnosis of the mental disorder out of which risk arises (see Para. 2.6) to meet the criteria for section 2 detention.

This was the second time I have met this comment and I can’t work out what the difference is between a diagnostic classification and a diagnosis. Paragraph 14.75 is headed by a ‘must’ which earlier is classed as a requirement for which there are no exceptions, a ‘should’ requires a credible explanation for deviation.

I wonder if the confusion arises from the ‘detained for assessment under section 2’ wording. As the MHA requires a mental disorder to be present and the Code requires documentation of symptoms and behaviour plus a diagnostic classification to start with, I presume the further assessment during detention is mainly to determine treatment and perhaps persistence of the disorder.

Any ideas?

I can see it’s slightly ambiguous, but I don’t think the words “not merely” [a diagnostic classification] imply “as well as”.

Rather, it means “don’t write nothing but a diagnostic classification”.

Say, for example, you asked me to give an opinion on a controversial figure “in measured tones, not merely a stream of abuse” - you wouldn’t expect me to give you a measured answer AND a stream of abuse.

An interesting point of view, but in the context of the second sentence of 14.75 it is clearly asking for further details about something supposed to be already established i.e. the presence of a mental disorder as opposed to your example where the object is to avoid a stream of abuse.
Your interpretation of the sentence as meaning ‘don’t write nothing but a diagnostic classification’ seems to mean that the diagnostic classification has to written. So you seem to agree that if diagnostic classification means a diagnosis then the point of view that there is no requirement for a diagnosis is incorrect. Is that what you mean?

I agree with Richard. If we consider Parliament’s intention here, it was certainly not to require a wholly unrealistic demand of a diagnosis following a MHA assessment for someone who is previously unknown to services but exhibiting acute symptoms of mental disorder and considerable risk. The requirement is to establish evidence of mental disorder and ‘risk’ (as defined in the Act)

This is worth a look: 11 11…15 (

Sorry if I was unclear. I interpret the Code to mean that it is neither sufficient NOR necessary to include a diagnostic classification.

In this context, diagnostic classification and diagnosis mean different things. The only diagnosis required by the Act is “mental disorder”. There is no requirement to identify or state which particular class(ification) of mental disorder. Precisely because, as Steve says, that will often be impossible without further assessment.

Nick Woodhead’s reference is most illuminating and seems to confirm my understanding of the MHA and Code i.e. there is a mental disorder out of which risk arises to justify detention. You should be aware I am not qualified in either law or mental health care, but I am qualified by being closely connected with the non compliant detention aspect.
Steve Chamberlain’s point is well taken, but the MHA does not provide for the scenario described. As a guess I would think doctors could list out the behaviours and acute symptoms displayed by the subject and make a provisional diagnosis acknowledging the circumstance of it being a new contact. The examples of behaviours shown in Nick’s semanticscholar reference are, if present ,fairly convincing indications of disorder.
At this stage it appears that the notion that there is no requirement for a diagnosis of mental disorder is incorrect, but there may be other points still to come.

Just to hopefully finally clarify, the Upper Tribunal has confirmed that there is no requirement for a diagnosis in section 2 hearings.
See JP v South London and Maudsley NHS Foundation Trust [2012] UKUT 486 (AAC) - para 13.

OK well running with your perception, is it necessary to document the behaviours and symptoms that indicate a mental disorder or is it sufficient to rest on being a doctor as having an opinion that there is a disorder without explaining how the opinion was arrived at?
Also, again not being qualified, and as the Code Paragraph 2.6 clarifies, the risk arises from the disorder, but not all disorders carry risk, so at least the reasons for the general there is a disorder statement would need to tie it down to those that carry risk.

Steve C’s reference is a clarification of Richard Rook’s point, and with respect to Leonard Cohen’s Suzanne I sink beneath your wisdom like a stone. Although bobbing up again the case had lots of background information about the subject’s delusional behaviour, so in my innocence of the law how does this case provide a blanket assumption that an unspecified mental disorder can be assumed to lead to risk as a sufficiently strong reason as in Steve C’s reference para 18 ’ The Tribunal’s decision is materially defective in law for inadequate reasoning, bearing in mind this was a matter in which a person’s liberty was at stake’. So out of this I come to a point of view that the behaviours and symptoms are key, the justification for detention must rest on the severity of these factors clearly indicating some kind of mental disorder, with adequate reasoning which can somehow be linked to risk with adequate reasoning.
Is this a reasonable stance?
Depending on any further points I may resurrect my original non compliant section 2 topic again to see if any further insights evolve.

I am still trying to find the difference between a diagnosis and a diagnostic classification. Although I agree there could be an interpretation that all that is needed is a list of behaviours and symptoms that lead to a conclusion of an unspecified or provisional mental disorder which in some cases where the list of signs and symptoms is comprehensive and convincing to that being sufficient, I can’t understand why the authors of the Code added the comment about diagnostic classification. This is a cut from a google search,

The authors distinguish between diagnostic criteria—the collection of signs and symptoms used by doctors to diagnose and treat a patient’s condition—and classification criteria—the standardized definitions of a condition mainly used to create a uniform group of patients for clinical research.6 Aug 2015

Another search suggests that the classification is related to the DSM system.

I wonder if this cut from MHA Code of Practice is a diagnostic classification list.

2.5 Examples of clinically recognised conditions which could fall within this definition are given in the following figure

• Affective disorders, such as depression and bipolar disorder
• Schizophrenia and delusional disorders
• Neurotic, stress-related and somatoform disorders, such as anxiety, phobic
disorders, obsessive compulsive disorders, post-traumatic stress disorder and
hypochondriacal disorders
• Organic mental disorders such as dementia and delirium (however caused)
• Personality and behavioural changes caused by brain injury or damage
(however acquired)
• Personality disorders (see paragraphs 2.19 – 2.20 and chapter 21)
• Mental and behavioural disorders caused by psychoactive substance use (see
paragraphs 2.9 – 2.13)
• Eating disorders, non-organic sleep disorders and non-organic sexual disorders
• Learning disabilities (see paragraphs 2.14 – 2.18 and chapter 20)
• Autistic spectrum disorders (including Asperger’s syndrome) (see paragraphs
2.14 – 2.18 and chapter 20)
• Behavioural and emotional disorders of children and young people
(Note: this list is not exhaustive)

If these fit the bill then the section 2 recommendation report, hopefully following the Gold Standard as in Nick Woodhead’s reference 11 11…15 ( reference, would contain ‘the signs and symptoms xyz fit into the category one of the above’

Any ideas?

The original question was about this part of the Code:

When giving a clinical description of the patient’s mental disorder as part of these reasons, doctors should include a description of the patient’s symptoms and behaviour, not merely a diagnostic classification.

I agree with Richard’s interpretation that diagnostic classification is neither necessary nor sufficient. In other words, the clinical description does not need a diagnostic classification at all, but if it only contained that then it would be deficient.

I’m not sure whether there is any relevant difference between “diagnostic classification” and “diagnosis”, as one includes the other. I imagine that the Code’s authors had in mind was something as generic and brief as “F20.0 paranoid schizophrenia”.