Over the last few years, psychology has been central to a project that promises to dramatically improve the way we diagnose our clients: the development of the section on mental and behavioral disorders of the International Classification of Diseases (ICD-11), to be released in 2014.
Many of you are familiar with the ICD only as a reimbursement tool, one that you use to code for billing, as required by the Health Insurance Portability and Accountability Act. When it comes to diagnosing their clients, most psychologists still rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The ICD, however, is a much more comprehensive system, in that it covers all health conditions, not only mental disorders. The ICD is the global standard for diagnostic classification for health reporting and clinical applications across all diseases, disorders, injuries and related health problems. The system is overseen by the World Health Organization, the United Nations entity whose mission is attaining the best possible health for all people. As the only organization in the world with the ability to secure global cooperation and agreement on health issues, WHO is uniquely positioned to create and promote global health standards.
For the first time in the ICD’s history, psychologists are involved in the development of the new ICD classification of mental disorders — previously, only psychiatrists were included. APA, as the world’s largest psychological association, is critical to this effort. In partnership with the International Union of Psychological Science, APA is supporting psychology’s input into the ICD revision project at WHO.
Our priority with the ICD revision has been to make the system an even more clinically useful tool that will better capture patient conditions. Currently, there are several significant challenges in using both the DSM and the ICD. For example, both systems are highly complex, requiring clinicians to remember as many as 20 to 35 pieces of information to make one of more than 400 diagnoses. Another problem is that under both diagnostic systems, many patients meet the criteria for two or more disorders, and there is no distinction between situations in which co-morbidity is an artifact and those in which one disorder confers risk for another. In addition, a high proportion of mental disorder diagnoses are recorded as disorders “not otherwise specified,” suggesting that health professionals do not have categories that accurately describe their patients.
As a result of these and other problems, many patients often don’t get the accurate and precise diagnosis they need to access the best care. That will change under a new and improved ICD. Our goal is to make the revision more user-friendly by ensuring that its diagnostic categories align with actual clinical experience — and psychologists have much to contribute both in terms of research and practice insights. Psychologists from around the world are serving on the working groups that are proposing changes to the ICD’s specific sections, such as personality disorders, mental health problems among children and intellectual disabilities.
The revised ICD will also embrace technology to allow interactive information-sharing. Researchers will be able to track data with finer subcategories that are relevant to their work. Eventually, the data will be integrated into health informatics systems, accessible worldwide. The data will be aggregated at the clinic, health system and country levels and used in a variety of ways, such as to help determine treatments, outcomes, reimbursement and even health policy.
How might you get involved with the ICD revision? The World Health Organization is starting its field research for the ICD, which will include surveys that will be sent to a random sample of APA members. The purpose of these surveys is to gather information about what changes to the system will be most clinically useful for psychologists. I urge you to participate if you receive a survey. It is a great opportunity for you to have input now on a system that will improve patient care worldwide and for generations to come.