Social determinants recorded in only 0.2% of mental health contact cases

The environmental and social circumstances of individuals using mental health services in a North West city region– including those diagnosed with “post-traumatic stress disorder” – were recorded in only 0.2% of cases, according to new analysis published in the Journal of Mental Health.

The University of Liverpool’s Professor Peter Kinderman and team investigated 21,701 individual cases that had first contact with the city region’s specialist NHS mental health provision between 1 January 2015 and 1 January 2016.

They found that the ‘social determinants’ of mental health problems were only recorded for a total of 39 individuals (0.2%), despite the well-established mental health risk factors of poverty, homelessness, adverse experiences in childhood and living alone.

Incredibly, although a primary diagnosis of “post-traumatic stress disorder” (PTSD) was given to 66 people, only two people in that group recorded the vague “specified problems related to psychosocial circumstances”, while no social determinant was recorded for the any of the other 64 individuals.

Professor Peter Kinderman said: “This is a significant finding. The diagnosis of PTSD quintessentially requires the identification of a traumatic event; the individual is distressed following, and consequent upon, a major life event. And, to be clear, no specific traumatic events were recorded for any of the persons diagnosed with PTSD.”

Again, 25 people were diagnosed with “adjustment disorder” – which likewise requires the diagnostic presence of a triggering event – but zero social determinants were recorded and no traumatic events listed.

Similarly, 151 people were diagnosed with “emotionally unstable personality disorder”, but only one case – alleged sexual abuse – was recorded as a possible social determinant.

Previous studies have shown that traumatic events in childhood account for 31% of all mental health issues, while even “living alone” has been shown to account for 11%.

Professor Peter Kinderman added: “The omission of records of the social determinants of mental health problems is important.

“Research has shown that including this information reduces the likelihood that a pattern of behaviour is seen as pathological, while not including it increases the likelihood of a biomedical explanation.­­­­­­­­

“Comparison with known rates of incidence of social determinants of mental health problems – unemployment, homelessness, social isolation, childhood trauma – suggests clinicians are very significantly under-reporting these issues.

“Data on social and contextual factors are vital to public health approaches that see mental health as a community, not individualised, issue.”

Minimal use of ICD social determinant or phenomenological codes in mental health care records by Professor Peter Kinderman is published in the Journal of Mental Health. To read the full report, please visit: