Clinicians ‘miss mental illness diagnosis in more than one in four patients’

Severe mental illness diagnoses are being missed by medical staff in more than one in four patients admitted to hospital for other health conditions, research suggests.

Data analysed by scientists at University College London indicates that, among those with previously diagnosed mental illnesses, people from ethnic minority groups more likely to have their condition go unnoticed by clinicians.

But the researchers say their findings, published in Plos Medicine, suggest the situation has improved over the last decade, with data from 2006 showing severe mental illness diagnoses were missed in more than 50% of cases.

Hassan Mansour, of UCL Psychiatry, who led the study as part of his masters degree, said: “When someone is admitted to hospital, it’s important that the medical staff are aware of their other conditions, as these might affect what treatments are best for them, in order to provide holistic care.

“We found encouraging signs that clinicians are more frequently identifying severe mental illnesses in hospital patients than they were a decade ago, but there’s a lot more that can be done, particularly to address disparities between ethnic groups, to ensure that everyone gets the best care available.”

The researchers looked at more than 45,000 emergency hospital admissions of nearly 14,000 adults with severe mental illnesses, from 2006 to 2017.

They found that mental illnesses recorded during hospital admissions were 48% in 2006, which rose to 75% in 2017.

The researchers say this improvement over time “may be due to NHS commitments towards whole person-centred care, financial incentives, improvements in coding practices, or expansions of liaison psychiatric services in hospitals”.

Across the whole study period, the team found mental illnesses, on average, were recorded during admission 70% of the time.

However, they said not all of the recordings included the specific diagnosis, with recording of schizophrenia occurring in 56% of people with this condition and bipolar disorder recording occurring in 50% of those who were previously diagnosed with the illness.

The team also found patients from ethnic minority backgrounds were more likely to have missed diagnoses, particularly those from black African or Caribbean communities who were 38% more likely to have their diagnosis unrecorded compared to patients from white ethnic backgrounds.

The researchers believe language barriers or stigma felt by patients could play a role, while also adding that clinicians may be less able to detect these conditions in people from other ethnic and cultural groups.

Mr Mansour said: “The disparities we found between ethnic groups are concerning because previous studies have identified particularly poor health outcomes for people from minority ethnic groups with severe mental illnesses.

“Training in culturally-sensitive diagnosis may be needed to reduce inequalities in medical care.”

Based on their findings, the researchers are calling for better sharing of data between health services.

Senior author Dr Andrew Sommerlad, of UCL Psychiatry and Camden and Islington NHS Foundation Trust, said: “It’s important to understand that physical and mental health are interlinked, and should not be seen as separate entities.

“Both can impact the other, so more needs to be done to bridge the gap and achieve truly integrated care that’s accessible to everyone.”