For my internship I am doing assessments of new patients in nursing homes. Every patient has what is called a "Level I Assessment" in their file (I don't do those - they are completed upon admission). Part of the Level I screenign is to identify patients who have "serious mental illness," which includes (in this state) Schizophrenia, Other Psychotic Disorders, Panic Disorder, Other Severe Anxiety Disorders, Depression or Bipolar Disorders, Somatization Disorder, and Borderline Personality Disorder.

When I (or the psychologists that I work with) do these assessments, we are told not to diagnose anybody with Depression, etc, because then the nursing home would be required to do a Level II Assessment, which involves calling in more specialists, and there are rules limiting how many Level II patients can be in the nursing home, and it's generally a big pain. So we say that the patient has "symptoms of depressed mood" instead. If someone comes in with a prescription for a mental illness, they get the doctors to write a clarification that the person has, for example, "celexa for depressive features related to life circumstances." They don't want mental illness dx on the charts.

In reality, more than half of the nursing home patients I assess have depression or anxiety or something significant. Some of them severe. We are allowed to offer treatment, if the person qualifies, but I think it's frustrating that we can't call it what it is, and that so many don't get treatment who could use it.