Hospitals miss mental illness diagnosis in more than 25% of patients

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In a new study, researchers found severe mental illness diagnoses are missed by clinicians in more than one quarter of cases when people are hospitalized for other conditions.

People from ethnic minority groups are even more likely to have previously diagnosed mental illnesses go unnoticed by medical staff.

However, researchers found the situation is improving, as data from 2006 showed that severe mental illness diagnoses were missed in more than half of cases.

The research was conducted by a team at UCL.

The large cohort study involved 13,786 adults who had diagnoses of severe mental illnesses, which included bipolar disorder and schizophrenia, from 2006 to 2017.

They linked the data to 45,706 emergency hospital admissions for the same people over the same period, to see whether their previously-diagnosed mental illness was recorded when they were admitted to hospital for a physical health issue.

Across the whole study period, mental illnesses were recorded at hospitalization 70% of the time, after a prior diagnosis. This figure rose from 48% in 2006 to 75% in 2017.

The researchers say the improvements 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.


The researchers found that people from ethnic minority backgrounds were more likely to have missed diagnoses.

The researchers say this may have been due to clinicians being less able to detect these conditions in people from other ethnic and cultural groups, or perhaps language barriers, or stigma felt by patients.

Doctors also missed diagnoses more frequently for married people, which the researchers say could be due to stigma, if spouses providing information to hospital staff are reluctant to mention a mental illness diagnosis, or are unaware of it.

The team says knowing that a patient has a severe mental illness can be important for their treatment, as they might benefit from additional support after being discharged, and they may also need to continue taking their psychiatric medications, or even make changes to these, while in hospital.

The researchers are calling for better sharing of data between health services.

One author of the study is Hassan Mansour (UCL Psychiatry).

The study is published in PLOS Medicine.

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