Have we reached a transformative moment for mental health care at APA?

By: Dave Emerson, Co-Founder, Director of research and public policy at CFTE 

As of this moment, mental health diagnoses revolve around symptoms. Having an accurate diagnosis has likely saved millions of lives, literally, but the reliance on symptoms has also come with some significant downsides. For our purposes, the most important of which is that underlying conditions, causes are, at best, treated as incidental and at worst entirely ignored. This approach effectively puts the onus on the individual, or, to put it more nefariously, it blames the victim for their "state". The person with a mental health diagnosis is treated as a burden to a society that deems "mental illness" as a pathology, and effectively says to that person: it's on you to clean this up. Putting aside the fact that many people will forgo mental health care if it means carrying even an accurate diagnosis (for cultural, professional, religious, or personal reasons) - perhaps an issue for another day - the current symptom-based diagnostic system leaves the individual holding the bag without any recognition of how they got there.

Questions the western medical system has not done a good job of asking are: how did this person arrive at the diagnosis I am giving them? And what does it mean to consider those underlying conditions? I get it, these are big questions that have the potential to completely transform the way we think about mental health and mental health care. Taking them on is no small thing. 

In response to decades of high-quality research, the American Psychiatric Association (APA) appears to be shifting seriously toward consideration of underlying conditions as functionally salient - perhaps primary? - when it comes to mental health. Understanding social determinants of health and trauma exposure of drivers behind the diagnosis could transform our system of care, putting more scrutiny on systems that create inequities and generate trauma (racism, gender violence, war fighting, etc.), and taking some of the pressure off of the individual for being impacted by these systems.  Perhaps we are headed toward a day where a diagnosis is less of an albatross for an individual and more of a red flag that an entire system needs to be attended to - perhaps healed.

To learn more: https://www.npr.org/2026/01/28/nx-s1-5684121/dsm-5-american-psychiatric-association-diagnostic-mental-health