Abstract
Aims and method This paper investigates the relationship between cluster (Mental Health Clustering Tool, MHCT) and diagnosis in an in-patient population. We analysed the diagnostic make-up of each cluster and the clinical utility of the diagnostic advice in the Department of Health’s Mental Health Clustering Booklet. In-patients discharged from working-age adult and older people’s services of a National Health Service trust over 1 year were included. Cluster on admission was compared with primary diagnosis on discharge.Results Organic, schizophreniform, anxiety disorder and personality disorders aligned to one superclass cluster. Alcohol and substance misuse, and mood disorders distributed evenly across psychosis and non-psychosis superclass clusters. Two-thirds of diagnoses fell within the MHCT ‘likely’ group and a tenth into the ‘unlikely’ group.Clinical implications Cluster and diagnosis are best viewed as complimentary systems to describe an individual’s needs. Improvements are suggested to the MHCT diagnostic advice in in-patient settings. Substance misuse and affective disorders have a more complex distribution between superclass clusters than all other broad diagnostic groups.
Highlights
Aims and method This paper investigates the relationship between cluster (Mental Health Clustering Tool, MHCT) and diagnosis in an in-patient population
Two-thirds of diagnoses fell within the MHCT ‘likely’ group and a tenth into the ‘unlikely’ group
Improvements are suggested to the MHCT diagnostic advice in in-patient settings
Summary
Primary discharge diagnosis was available for three-quarters of these (n = 2094): half were accounted for by affective disorders (n = 552, 26%) and schizophrenia and related disorders (n = 533, 25%). In 6 of the 17 clusters the likely diagnoses accounted for less than 65% of the cases and made up half or less of cases in clusters 3, 4, 10, 15 and 18. In four of the clusters in the psychosis superclass (clusters 11, 12, 15 and 16) the ‘unlikely’ diagnoses accounted for between 11 and 17%. Alcohol and substance misuse was the primary diagnosis for a fifth of cluster 10, whereas depression accounted for 10%. Substance misuse and affective disorders were split between the psychosis and non-psychosis superclass clusters. The only exception to this was depression with psychosis (Table 3)
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