WHO Improves ICD-11 Focus on Mental Health Care in Primary Care Settings

The World Health Organization's (WHO) International Classification of Diseases 11th edition (ICD-11) is undergoing a major revision in regard to mental health and primary care.

Although changes to the ICD-11 (eleventh edition) cover a wide range of diseases, there has been a particularly dramatic shift in the section on Mental and Behavioral Disorders in an effort to address a "mental health gap," wherein patients suffering from mental health disorders remain diagnosed, but untreated in primary care settings.

This has led to the creation an additional version of the ICD-11 Mental and Behavioral Disorders section explicitly for use by primary health care providers in clinical settings.

A WHO "Working Group" of primary care physicians (PCPs) and mental health professionals is focused on increasing the utility of the ICD-11 for mental health diagnoses and guidance in connection with clinical use in primary care settings. Researchers field-testing the revised PCP-focused tools have reported positive outcomes to clinical tests of screening scales and tools based on the proposed ICD-11 changes to mental disorder classifications.

Wolfgang Gaebel, MD, president of the European Psychiatry Association; Jürgen Zielasek, Dr. Med., senior physician at the Clinic and Polyclinic for Psychiatry and Psychotherapy at Heinrich-Heine-University in Düsseldorf, Germany; and Geoffery M. Reed, MD, PhD, senior project officer, Revision of ICD-10 Mental Health and Behavioral Disorders at the World Health Organization in Geneva, Switzerland, published an overview of some of the major changes in the WHO ICD-11 related to mental health.

The group wrote that the ICD-11 is intended as a "freely available and open global resource, usable as a tool for clinical practitioners, researchers, patients, administrators, policy makers, and governments" to ease the clinical burden of identifying, and treating mental health disorders worldwide, stressing the importance of PCP involvement in lifting the global mental health care burden.

In an editorial for Salud Mental, Reed, with colleague Rebeca Robles-Garcia, Drs, wrote that "due to the significant treatment gap for mental disorders, as well as the shortage of mental health professionals around the world, it has been proposed that the identification and management of common mental disorders needs to be carried out in primary care settings."

The revision of ICD-11 for PCP includes what Reed and Robles-Garcia stated are the "27 mental disorders considered to be most clinically relevant in these [Primary Care] settings, either because they are common (such as depression) and/or because it is important that they are recognized by first-contact health care providers."

Diagnostic tools and screening mechanisms, treatment models, and techniques, and evidence-based guidelines provided in the ICD-11 for PCPs are “specifically designed for implementation in primary care settings” and can “make an important contribution to the development of the capacity of primary care professionals to be more involved in the management of the mental health problems experienced by their patient.”

David P. Goldberg, DM, with the Institute of Psychiatry in London (pictured), was chosen to lead the WHO Working Group focused on Mental Health and Primary Care, currently conducting clinical field studies utilizing proposed ICD-11 diagnostic guidelines.

A series of studies, led by Goldberg, have been released in 2017 testing new/revised screening scales, training, and tools based on ICD-11 reclassifications of mental disorders, including 2 that tested a series of screening tools for anxiety, depression, and anxious depression for use by PCPs.

Goldberg told MD Magazine that he felt that the revised classification of mental disorders for PCPs in the ICD-11 may help patients get the care they need. Through training and reclassification, PCPs can better address and diagnose patient symptoms, better understand the links between psychological and physiological disorders, and improve detection of mental disorders overall, according to Goldberg.

Goldberg told MD Magazine that the 2 “brief scales for anxiety & depression worked very well, administered by the PCPs themselves.” The screening scales successfully predicted diagnoses with 90% sensitivity and 88.5% specificity, creating a tool that Goldberg and colleagues agree can potentially fill a great need in PCPs for “feasible and accurate screening procedures for depression and anxiety.”

The proposed changes for ICD-11 provide explanations for multiple somatic symptoms across multiple body systems and guide PCPs treatment of patients suffering from such disorders. Goldberg told MD Magazine that he believes the new designations will dissuade PCPs from using the potentially harmful "all in your head" approach to patients exhibiting somatic symptoms.

Clinical field studies, like those performed by Goldberg, will determine ease of use, and "goodness of fit" in everyday global clinical practice by PCPs, and will work to provide objective assessment tools for diagnosis, and guidelines for treatment, according to Gaebel, Zielasek, and Reed.

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