How Mental Health Conditions Are Assessed and Diagnosed

Stories, signs to notice and what to do

Eleven Questions, One Long Breath

Nomvula, forty-one, had put off her first appointment with a psychiatrist in Durban for six months. She was afraid the doctor would judge her or write a label that would follow her. Her sister Thandi came along and carried a small notebook.

The doctor began by asking what had been happening. Nomvula described waking at three each morning, losing interest in her shop, and being unable to concentrate. The doctor asked about sleep, appetite, work, family, money, alcohol and her childhood. Nomvula's voice shook at some of the questions, but she answered honestly. When asked about thoughts of self-harm, the doctor was kind and direct. Nomvula admitted that she had wished not to wake up.

The doctor explained that this question is routine, not a sign that she was seen as dangerous. She watched Nomvula's speech, mood and concentration, asked about medicines, and ordered blood tests to rule out physical causes. A short questionnaire was done too. With Nomvula's permission, Thandi added what she had seen.

At the end, the doctor said it looked like depression, called it a working diagnosis, and explained treatment options with benefits and risks. Nomvula used her sister's list and asked: 'How long before I might feel better? What should I do if things get worse?' She left with a plan, a review date and, for the first time in months, a feeling of relief.

How to recognise it

Delay in seeking help because of fear of judgement or labels.
Sleep, appetite, energy and interest all changed for weeks.
Difficulty concentrating, and an effect on work and family life.
Thoughts of not wanting to live, which must be mentioned to the clinician.
Worry about what a diagnosis will mean for identity and privacy.

What this story explains

This story shows the steps of a good assessment: the interview, mental state examination, a questionnaire, physical checks, information from others, a risk check, and a formulation with a working diagnosis and plan.

Probable root causes

Fear of stigma and being labelled.
Not knowing what happens in an assessment.
Symptoms that make it hard to take the first step.
Pressure of work and family duties.
Belief that a diagnosis will define who you are.

What to do

Write down your symptoms, when they began, and what makes them better or worse.
Bring a list of medicines and physical illnesses.
Take a trusted person with you, if you wish, and give permission for them to speak.
Answer honestly, including about safety, alcohol and drugs.
Ask your questions: what is my diagnosis, how certain is it, what are my options?
Ask what to do if things get worse and when the review will be.

Whom to consult

Family doctor as a first step, especially if you do not know where to begin.
Psychiatrist or clinical psychologist for a full mental health assessment.
Counsellor for support while waiting for a specialist visit.
Emergency service or nearest hospital if you have thoughts of ending your life or are in danger.

Do and don’t

Do	Don’t
Do prepare notes.	Don't hide thoughts of self-harm.
Do be honest, even when it is hard.	Don't expect an answer in minutes.
Do ask questions.	Don't treat a diagnosis as a life sentence.
Do bring someone you trust.	Don't diagnose yourself beforehand.
Do ask for a review date.	Don't skip the physical tests.

How to behave and communicate

As a companion: 'I will come with you, and I will only speak if you want me to.'
Listen without interrupting her account.
Avoid saying 'you are fine' or 'just try harder.'
To the clinician: 'Can you explain that in plain words?'
Use a calm, supportive tone and let her set the pace.

Seventy-Four Per Cent on the Internet

Aiden, twenty, a university student in Melbourne, found a video called 'Signs you have ADHD' and a quiz that gave him a score of seventy-four per cent. He had been distracted, restless and behind with assignments. By evening he was telling friends he had ADHD and anxiety and probably something else.

His roommate, Luca, noticed he was panicking, not relieved. Aiden had also not slept for two nights, partly from exam stress. Luca said, 'Maybe those quizzes are not the answer. Why not ask a doctor?'

Aiden booked a visit with his university health centre. The doctor explained that a screening tool is a short test that flags who may need a full assessment, and that a high score means 'talk to a professional,' not 'you have the condition.' She then did a proper interview, checked his sleep, asked about caffeine and alcohol, and arranged blood tests.

She used a standard questionnaire, which supports judgement and does not replace it. Aiden learned that poor concentration occurs in many conditions: anxiety, sleep loss, depression, thyroid disease and ADHD. The doctor noted that the plan would be reviewed. 'The result of this questionnaire is one piece,' she said, 'and you are a whole person.' Aiden left relieved, with sleep advice and a next appointment.

How to recognise it

Using online quizzes or social media videos to give yourself a diagnosis.
Sleep loss, stress or caffeine overlapping with symptoms such as poor concentration.
Anxiety about a score and a sense of being 'labelled.'
Traits described online that are common in everyone.
Delay of proper care because of a wrong label.

What this story explains

This story shows the difference between screening and diagnosis, why online quizzes are unreliable, and why symptoms overlap across conditions so a full assessment is needed.

Probable root causes

Easy access to social media lists and quizzes.
Real stress, poor sleep or study overload.
Worry and the wish for a quick explanation.
Symptoms that overlap between many conditions.
Little understanding of how diagnosis actually works.

What to do

Treat online results as a reason to talk to a professional, not as an answer.
Note symptoms, duration and impact on study, work and relationships.
Book a visit with a family doctor or health centre.
Describe sleep, caffeine, alcohol and medicines honestly.
Accept that physical tests may be part of the assessment.
Ask what the screening score means and what the next step is.

Whom to consult

Family doctor or student health service for a first assessment.
Clinical psychologist or psychiatrist for a full evaluation.
Counsellor for stress and study problems while waiting.
Emergency service or hospital if distress becomes unbearable or you have thoughts of self-harm.

Do and don’t

Do	Don’t
Do bring any worries to a professional.	Don't self-diagnose from videos.
Do keep a sleep diary.	Don't label friends.
Do ask about screening versus diagnosis.	Don't ignore sleep and stress.
Do be patient with the process.	Don't treat a score as proof.
Do keep an open mind.	Don't delay help for a long time.

How to behave and communicate

Friend: 'Those quizzes are not reliable. Shall we find a proper appointment?'
Listen without agreeing or dismissing his fears.
Avoid saying 'you are overreacting.'
To the doctor: 'My score was high. What does it really mean?'
Keep a calm, curious tone.

Thyroid, Not Just Nerves

Marta, thirty-eight, an accountant in Warsaw, had been anxious for months. Her heart raced, her hands trembled, she lost weight, and she could not concentrate at work. She was convinced she had a serious anxiety problem and was ashamed. She nearly cancelled her visit to the family doctor.

The doctor listened to the whole story and then asked about her sleep, her appetite and any physical illness. She examined Marta, checked her pulse and blood pressure, and ordered blood tests for thyroid function, blood count, vitamins and sugar. 'Because physical illness can mimic or cause mental symptoms,' she explained, 'we always look at the body as well as the mind.'

The tests showed an overactive thyroid. Marta was relieved and puzzled. She was referred to the right physician for the thyroid, while the doctor also taught her some calming practices and arranged a review of her anxiety after the thyroid treatment had begun.

Marta asked, 'So, am I not anxious?' The doctor said both could be true, since many people have more than one condition, and the plan would address all of them. She added that diagnosis rests mainly on a careful interview and observation, supported by questionnaires and physical checks. Marta left with a clear plan for body and mind.

How to recognise it

Anxiety symptoms such as racing heart, tremor, and weight loss that may have a physical cause.
Poor concentration and sleep that could come from many conditions.
Sudden or unusual changes with no clear life reason.
Shame and fear of being told 'it is all in the mind.'
More than one condition occurring at the same time.

What this story explains

This story shows that physical illness can mimic or cause mental symptoms, which is why blood tests and physical checks matter, and that comorbidity, having more than one condition, is common.

Probable root causes

An underlying physical illness such as thyroid disease.
Stress, which can make symptoms worse.
Sleep disturbance and heavy workload.
Overlap of symptoms between mental and physical conditions.
Delay in seeking help because of shame.

What to do

Tell the doctor about all physical symptoms, not only emotional ones.
Allow blood tests and a physical examination.
Bring a list of medicines, supplements and substances used.
Ask whether anything physical could explain the symptoms.
Follow the plan for both body and mind.
Return for review if symptoms do not improve.

Whom to consult

Family doctor first, for examination and blood tests.
Physician or endocrinologist for the physical condition.
Psychiatrist or clinical psychologist if anxiety or mood symptoms continue.
Emergency service or hospital if there is chest pain, severe breathlessness or thoughts of self-harm.

Do and don’t

Do	Don’t
Do mention physical changes.	Don't assume it is only nerves.
Do have the tests.	Don't skip tests out of fear.
Do ask about overlap.	Don't use online remedies instead of care.
Do follow up both conditions.	Don't stop treatment when you feel better.
Do be patient with the process.	Don't blame yourself.

How to behave and communicate

Say to the doctor, 'I am worried that something physical may be going on.'
Listen carefully to explanations and ask for plain words.
Avoid 'it is all in your head.'
To a friend: 'Let us get this checked properly.'
Use a calm tone and keep your questions written down.

A Diagnosis That Changed

Hamid, twenty-seven, from Birmingham, was diagnosed with depression two years ago after a long low period. A medicine helped for a few months. Then he suddenly felt wonderful: he slept two hours a night, talked quickly, spent money he did not have and started three business plans in one week.

His girlfriend, Sofia, was alarmed. When he crashed again into a deep low, she persuaded him to see the doctor and brought notes of what she had seen. With his permission, she described the highs as well as the lows.

The psychiatrist said that a diagnosis may be refined as new information appears. Someone first diagnosed with depression may later show episodes of mania, which can lead to a diagnosis of bipolar disorder. 'Your first diagnosis was reasonable,' he said, 'based on what we knew then. Now we know more.' He called it a working diagnosis and explained the changes to the plan.

Hamid felt sad, then relieved, then afraid of the label. He asked for a second opinion, which was calmly arranged, and the second doctor agreed. 'You are not your diagnosis,' said the psychiatrist. 'You are a person who has a condition.' Hamid decided to tell Sofia and his brother, and no one else for now.

How to recognise it

A diagnosis that does not fit the whole picture, or a treatment that is not working.
Periods of unusually high energy, little sleep and risky decisions, alongside lows.
A person or family who first saw only the depressed phase.
Reactions to the new diagnosis: sadness, denial, fear, relief.
Concern about stigma and who to tell.

What this story explains

This story shows that diagnoses can change over time, why information from others and second opinions are reasonable, and how to live with a diagnosis while keeping a sense of self.

Probable root causes

Early episodes that look like only one condition.
Lack of information about earlier highs or family history.
Natural change in the illness over time.
Treatment responses that reveal new patterns.
Overlap of symptoms between conditions.

What to do

Keep a simple mood and sleep diary, including the highs.
Share concerns about a change in pattern with the doctor.
With permission, let a trusted person give their observations.
Ask 'how certain are you and could anything else be going on?'
Ask for a second opinion if the diagnosis or treatment does not fit.
Take time to adjust, and decide carefully whom to tell.

Whom to consult

Psychiatrist for review of the diagnosis and plan.
A second psychiatrist for a second opinion, if desired.
Clinical psychologist for support in understanding and living with the diagnosis.
Emergency service or hospital if there is risk of harm to self or others.

Do and don’t

Do	Don’t
Do give the full history.	Don't hide the highs.
Do ask questions.	Don't use the diagnosis as a joke or insult.
Do take time to absorb it.	Don't stop treatment suddenly.
Do choose carefully who to tell.	Don't let the label define you.
Do keep appointments.	Don't diagnose a family member yourself.

How to behave and communicate

Partner: 'I noticed these changes and I would like the doctor to know.'
Listen with respect to the person's feelings about the news.
Say, 'You are still you.'
Avoid 'they must be wrong' or 'I told you so.'
To the doctor: 'What should we do if things get worse?'

Maya Will Not Sit Still, Or Is It More?

Maya, eight, in Hyderabad, had been called lazy and careless by her teacher. She lost her things, stared out of the window and sometimes cried before school. Her parents, Neha and Suresh, were told to wait and see. A year later nothing had improved, and Maya had started saying she was stupid.

Neha finally took Maya to a paediatrician. The doctor spoke with Maya in a gentle way, observed her at play and asked about pregnancy, early development, sleep and family. She asked the school to send a report and gave both parents and the teacher a questionnaire.

Because children cannot always describe their feelings in words, the doctor explained, assessment includes interviews with the child and carers, school information, observation and sometimes tests of learning or attention. She also ruled out hearing, eyesight and sleep problems.

A clinical psychologist later assessed Maya's attention and learning and found she had a specific learning difficulty and attention problems, as well as some anxiety. Neha said, 'I wish we had not waited.' The doctor replied that earlier help brings better results, and today was a good day. School adjustments, a plan for the family and regular review began, and Maya's mood lifted when the adults changed how they spoke to her.

How to recognise it

A child labelled lazy, careless or naughty with no assessment.
Difficulties persisting across home and school for months.
Tears, low confidence or avoidance of school.
Parents advised to 'wait and see' while problems continue.
Possible hidden causes such as hearing, vision, sleep or learning problems.

What this story explains

This story shows how children are assessed, using the child, parents, school, observation, developmental history and tests, and why waiting too long costs the child.

Probable root causes

Specific learning or attention difficulties.
Anxiety or low confidence from repeated criticism.
Undetected hearing, vision or sleep problems.
Family or school stress.
Lack of early assessment and misunderstanding of the child's behaviour.

What to do

Write down what you see at home and when it began.
Ask the school for specific examples and a written report.
Visit a paediatrician or child specialist, with the child comfortable and informed.
Share the developmental history from pregnancy and early years.
Check hearing, vision and sleep as part of the assessment.
Work with the school on adjustments and review progress.

Whom to consult

Paediatrician or family doctor for a first assessment and physical checks.
Clinical psychologist or child psychiatrist for developmental and learning assessment.
School counsellor or special educator for classroom support.
Emergency service or hospital if the child talks of self-harm or is in danger.

Do and don’t

Do	Don’t
Do act early.	Don't call her lazy or stupid.
Do speak kindly to the child.	Don't wait and see for too long.
Do share information between home and school.	Don't compare her with siblings.
Do praise strengths.	Don't blame parents or the child.
Do review progress.	Don't rely on one test alone.

How to behave and communicate

To the child: 'You are not in trouble. We want to understand what is hard for you.'
Listen to her words and play without correcting.
Avoid labelling her in front of others.
To the teacher: 'Can we share what we each notice?'
Keep your voice calm and encouraging.

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.