When a Mental Health Policy Change Meets a Youth Early-Intervention Service: Reflections on the Role of Diagnosis

Background

Psychiatric diagnosis often generates controversy regarding its necessity, validity and utility. While it can help determine service eligibility and guide clinical decision-making, a formal diagnosis can also reinforce negative stereotypes and self-stigma, particularly among adolescents and young adults in critical stages of identity formation.

Aim

In this article, we argue that a policy shift from a national, free-to-all funding to HMO-based coverage—with mandatory diagnostic documentation—might contradict the principles of early-intervention services for youth.

Method

Between 2016 and 2018, we collected routine data for an evaluation study of youth early-intervention services in Israel. During this period, eligibility changed from open access to a requirement of receiving a formal DSM diagnosis.

Results

Our secondary analysis shows no significant differences in demographic characteristics, psychological distress or social and occupational functioning before and after the policy change. However, clinicians reported a significantly higher proportion of youth meeting full diagnostic criteria for DSM diagnosis and expressed greater certainty in their assessments.

Discussion

These findings underscore the potential influence of policy on clinical judgement—or at least its documentation—demonstrating a paradox: a system intended to broaden early intervention may inadvertently hinge on a stigmatising label, potentially deterring help-seeking among youth. Financial and policy structures can challenge the low-barrier, youth-friendly framework that characterises early intervention in psychiatry. Further investigation is needed to understand the fragile dynamics of mental health coverage policy and the principles youth-oriented early-intervention services.