"Kodak" Diagnoses

Recently, I was reviewing a forensic psychiatric evaluation that brought to bear a dysfuction in mental health care and diagnostics—what the evaluator referred to as “Kodak Moment” diagnoses. For those who may remember the old Kodak commercials, this catch phrase was about using the camera to capture a "moment" a snapshot in time. It resonated with me as I reflected on its implications in the field of mental health. It’s a stark reminder of how often our mental health system relies on quick and superficial assessments, which can have long term detrimental consequences to those struggling with severe psychiatric conditions.

In many cases, especially with disorders that involve psychosis, it's not uncommon for multiple psychiatrists or nurse practitioners to offer these snapshot diagnostics. Unfortunately, an unstable psychiatric condition is challenging—if not impossible—to diagnose and treat effectively in a hospital or outpatient setting. This is primarily due to the limited interactions between care providers and patients; there simply isn’t enough time or personal interaction to gather a comprehensive understanding of an individual's condition.

I have witnessed firsthand the tragic consequences of this approach. There are heartbreaking stories of individuals grappling with severe delusional disorders and suicidal ideation being admitted to hospitals, only to present a convincing but completely fabricated narrative to their psychiatrist. After being released, these individuals often go on to fulfill the tragic intentions only days after their release. Even after an involuntary commitment, these patients are frequently referred to intensive outpatient programs because that’s the hospital protocol, that’s all they know.

It’s disheartening to observe how inept our mental health system can be for someone suddenly confronted with severe mental illness and its often devastating symptoms. While many describe the mental health system as "broken," I am unaware of its ever having been functional in the first place. This inept and dysfunctional system is part of what gave rise to the private-pay treatment world; often financially out of reach for the average person. If you want to hear some stories about the hospital system, ask Co-Founder of CooperRiis, Lisbeth Cooper, what caused her to open their private residential treatment Therapeutic Community.

In my podcast, #MentalHealthMatters, I consistently ask my guests how we can improve the system and enact meaningful change. The pervasive use of snapshot or "Kodak" diagnostics has no place in diagnosing or treating serious mental health disorders. I had to advocate with a group of professionals recently for a stabilization period for a client experiencing psychosis, stressing that it is standard practice to allow for a period of stabilization before conducting a full assessment. Psychosis is a intensely loud experience for the mind, so loud it will drown out other underlying factors and skew an assessment unless the brain is given a chance to cool off. A standard practice by the leaders in the field but still not widely recognized or observed as a protocol among mental health professionals.

In one instance, a Nurse Practitioner spent only an hour with a client hastily arriving at an inaccurate diagnosis. This decision, made in isolation and without proper supervision, resulted in the client being taken off their antipsychotic medication. Naturally, the individual had another psychotic episode and yet another trip to the hospital, forcing them to restart their treatment and recovery process all over again.

Unfortunately, these stories are not isolated incidents; they represent a widespread issue within our mental health care system. I believe we are long overdue for working towards a more thoughtful and thorough approach to mental health treatment, ensuring that we prioritize understanding over convenience. Only then can we hope to improve outcomes for those who desperately need our help.

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