7.5 Screening, assessment and diagnosis

Screening

Screening procedures are designed to identify whether someone might have a mental health and/or a substance use problem, and whether he or she should have a comprehensive assessment.

People who work in the substance use and mental health fields are encouraged to expect to see concurrent disorders rather than see them as an exception. However, some mental health agencies still don't screen clients for substance use problems, and some substance use agencies don't screen clients for mental health problems. When your family member begins treatment, ask if both problems have been considered.

Assessment

Assessments usually start with a conversation with the health care provider. Questionnaires are often part of the assessment interview. The treatment provider investigates how the substance use and mental health problems interact. During an assessment, people are often asked to discuss things such as:

• why they have come for help, what kind of help they are looking for and what has helped in the past
• their physical condition
• general life problems, troubling thoughts or feelings, substance use problems, as well as how long problems have lasted
• whether they have experienced or seen violence (e.g., physical or sexual assault, war), even if it occurred years before
• whether there is a history of substance use or mental health problems in their family
• what their life is like (e.g., how they feel, what they think, how they sleep, if they exercise and socialize, how they do at school or work, how their relationships with friends and family are)
• whether they've come to Canada in the last few years and/or whether they've come from a war-torn country
• what, if any, medications they take.

The client and the treatment provider use the information from the assessment to develop a treatment plan.

Diagnosis

It is not always necessary to have a diagnosis before starting treatment. However, a diagnosis may help to direct treatment. For example, a diagnosis may determine if a particular kind of therapy would be most helpful and whether there are medications that could help treat the problem.

Even if your relative does receive a preliminary diagnosis, it may change or be interpreted differently by other health care providers over the course of treatment. It is often hard to determine whether symptoms are related to substance use or a mental health problem. The only way to figure out what you are dealing with is to see how the symptoms develop over time.

It's very difficult to identify the issues when it comes to mental illness and substance abuse. You know, cancer is much more clear-cut. And I don't think even the psychiatrists are really sure a lot of the time. They may be sure of the diagnosis, but they often don't help very much with the prognosis—and that doesn't help the cause of families, who know this is an illness that can respond to medication. We all need to view mental illness as something that can be treated, so at least there's hope out there! Having hope can make all the difference in the world.

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