Over the past 20 years, I have learned a great deal from mental health professionals. These lessons have informed the development of the ICD-11 chapter on Mental and Behavioural Disorders and the GCP.Network, and will continue to guide our work going forward.
Here are 3 of the most important:
- Clinical expertise is real. Practitioners and their concerns are a central component of the development of the ICD-11 classification of mental and behavioural disorders. In response, some have asked what practitioners could possibly contribute to the discussion, because after all, science should be the basis of the classification. Others have taken this to mean that we were managing the development of ICD-11 mental and behavioural disorders as a kind of popularity contest, making decisions about categories and diagnostic requirements based on whether or not practitioners “liked” them. In fact, ICD-11 Working Groups have carefully considered the available scientific evidence in developing their proposals for ICD-11 guidelines; the science/practice dichotomy is false in this instance.
But we have gone beyond traditional evidence reviews to develop a robust research agenda that places clinical utility at the centre and treats the extent to which the ICD-11 can be accurately and easily used by practitioners as a serious scientific question. This research agenda is already producing important findings. The International Advisory Group for ICD-11 Mental and Behavioural Disorders has stated, “People are only likely to have access to the most appropriate mental health services when the conditions that define identification, eligibility and treatment selection are supported by a precise, valid and clinically useful classification system.” If practitioners do not view the ICD-11 as clinically useful and as a worthwhile investment of their time, they simply won’t apply it consistently. In that case, information collected at the health encounter level cannot provide a valid basis for health policy or resource allocation at the system, national, or global level.
- Practitioners care about science. Through GCP.Network, thousands of practitioners have contributed directly to our field studies on the ICD-11. GCP.Network members understand how the ICD-11 will affect their lives and care enough to devote their time and energy to making it better. The scale of the response to the opportunity to participate in our studies has been beyond anything I could have anticipated.
This leads me to think that GCP.Network is also connecting to a larger issue: Many of us were trained in a scientist-practitioner model that, in daily life, is often difficult to implement. Most mental health professionals are swamped by overwhelming clinical demands in a world where there are not enough services to go around, and have few meaningful and feasible opportunities to contribute directly to research. GCP.Network provides health professionals with a realistic and sustainable model for participation in research that is larger than themselves and is tied to outcomes directly relevant to their own work. In this regard, it has been notable that our best participation in GCP.Network studies has often been among practitioners working in low- and middle-income countries.
- Practitioners want to do good work. People become mental health professionals because they want to make a contribution to others. They have chosen to work in an area that is routinely difficult and sometimes heartbreaking, at considerable personal cost, and are motivated to be as effective as possible in their roles. Over the coming months and years, throughout the development of ICD-11 and beyond, we plan to develop GCP.Network into an increasingly active platform for tools, learning and resources related to diagnosis and practice. The authority and dignity of health professionals has been under assault from many sources over the past decades, and we believe that GCP.Network can contribute to reclaiming it. Clinical utility will continue to be the litmus tests for our efforts, as it has been for our development of ICD-11 mental and behavioural disorders.
So, we hope that you will take from our new GCP.Network platform what is useful and tell us about what is not. This platform is intended as a way for us to give back to you. We have an astounding team of dedicated collaborators from around the world and are honoured to have you among them.
We are underway.