I am disturbed by the lack of publication and discussion about what I am seeing every day and what is arguably considered the foremost concern in the mental health field today, more specifically, the mis-, missed, and over diagnosis of mental illness.

I know that it is not popular or politically correct to say so, but I believe that a substantive portion of the mental health profession is missing the mark and has abandoned (or at least compromised) its roots and own standards of care. Let me provide a few examples of what I am seeing:

1) Overlooking drugs. Although overrepresented in my particular setting (corrections), illicit substances are an enormous problem in American mental health, but do not appear to receive their due respect in terms of how they impact (and even cause) mental health problems/symptoms. On a daily basis, I not only see such patients, but review records from large, well respected community mental health agencies. These records often (and I do not use this term lightly) will outline a heavy and sustained history of polysubstance abuse and then, in the very same record, diagnosis Bipolar or any number of other disorders. This is a no brainer. The DSM is explicit: you cannot diagnosis any mental illness if it is otherwise explained by drug intoxication or withdrawal. This is reckless and unethical misdiagnosis, which leads not only to stigma, but unnecessary and potentially harmful treatments.

2) Loosey goosey symptom interpretation. On a daily (and I do not exaggerate) basis, I see between 2 and 10 (seriously) patients who tell me they have Bipolar Disorder. As noted in #1 above, this is usually substantiated by the aforementioned records from mental health professionals who have diagnosed them. The rationale for said diagnosis is usually some version of "I can snap at any moment" or "I am happy one minute and angry the next." Once again: no exaggeration here. Many of these patients are heavily medicated with polypharmaceutical interventions from the outset and their "diagnosis" is based upon one interview. Again, no brainer. The DSM is clear: 7 days minimum of no/little sleep, grandiosity, recklessness. etc. As mentioned in #1, the only recklessness here is in the hands of unethical, poorly informed mental health professionals who cavalierly dole out diagnoses.

3) Discounting character. All of us know whether we choose to admit it or not, that character logical issues (Axis II stuff) are far more influential and potentially debilitating than most Axis I conditions - trust me, I work in the Cluster B capital of the world. Yet, contemporary mental health all but ignores personality - not just disorders, but the whole tamale - in lieu of searching for and loosely defining "symptoms" on Axis I.

The bottom line behind all of this is quite simple - not even radical. We need to get back to basics; back to the actual roots of what makes mental health professionals good at their jobs and different from all the other branches of healthcare: assessing and finding the root.

Taking a cavalier approach to diagnosis is dangerous, unethical, and it is producing a generation of victims who think they cannot get better or, even worse, that they are now disabled. The reality we choose to forget is that major mental illnesses are rare. The overwhelming majority of patients we will ever see: 1) do not have one and thus, are great candidates for a hopeful prognosis, 2) probably do not meet the actual criteria for any mental condition, thus, should not be diagnosed with one, 3) need to be referred to the least invasive treatment methods (psychotherapy) first and foremost, because, 4) (hold your breath) most patients do NOT need medication.

Dr. Rod Hoevet is a Clinical Psychologist in Missouri working in the corrections system and lectures at Maryville University. He is very concerned about some of the current trends in the mental health industry.