Mental health: implementing the International Classification of Diseases 11th edition

The Scottish Government is introducing the use of the mental, behavioural and neurodevelopmental (MBND) chapter of the International Classification of Diseases 11th edition (ICD-11 MBND) across all mental health services in Scotland as part of the Mental Health Transition and Recovery Plan.

The use of the ICD-11 MBND will start on the 1 November 2022. Initially it apply to mental health practitioners and clinicians involved in diagnostic procedures.

Why we are doing this

Our aim is to ensure that our approach to mental health services is based on the most up to date international understanding of mental illness. Scotland is set to be the first country worldwide to implement and promote ICD-11 for mental, behavioural and neurodevelopmental disorders.

We want to support health professionals to use globally agreed diagnostic standards through the implementation of ICD-11. This will allow for consistent, valid and comparable quantification of:

• health needs
• delivery
• costs
• morbidity
• mortality

The key goal is to help World Health Organisation (WHO) member countries reduce disease burden.

The key changes

ICD-11 replaces the tenth edition of the international classification of diseases which is now over 30 years old. ICD-11 incorporated the changes that have taken place since the tenth edition and more closely reflects how we think about health conditions today.

The move from ICD-10 to ICD-11 will benefit clinicians and patients, particularly in improving diagnostic interactions. 

The development of ICD-11 is intended to address gaps in the ICD-10 and incorporate medical updates, discoveries, and changes in thinking. ICD-11 also features updates to coding structures, digital-readiness and user-friendliness.

ICD-11 takes a lifespan approach. It is based on common underlying causes or contributing factors, including cultural considerations, to the development of a disease or condition.

Several new disorders are included in ICD-11 based on evidence of scientific validity, use in clinical settings and global applicability.

The Scottish ICD-11 Implmentation Group

The Scottish ICD-11 Implementation Group was established in April 2021 to support implementation of ICD-11. It is chaired by Dr John Mitchell CBE. Membership includes representatives from:

• Public Health Scotland
• The Royal College of Psychiatrists
• health boards
• public bodies
• related mental health professions
• lived experience organisations
• WHO

A letter from Professor Gregor Smith, Chief Medical Officer, was sent to NHS Boards in May 2022 advising them of the planned date for implementation.

Training and information

The WHO has developed specialist training for clinicians including 15 modules which cover specific areas of ICD-11 MBND.

The Royal College of Psychiatrists have produced a series of free webinars.

The NHS has produced a learning module on this which is specific to Scotland. You will need to login to your Turas account to view it. Turas is the NHS Scotland's platform. If you do not have a Turas account you can sign up for one. It is free. 

General information

The Scottish Government and NHS Education Scotland have produced an animation. It explains the key changes in an easy to understand and accessible way.

Data collection

Public Health Scotland (PHS) have created a lookup tool for the coding staff in Health Boards. This will allow them to select the appropriate ICD-10 code from the ICD-11 codes and any accompanying narrative in the discharge summaries. 

This is to continue collecting and publishing ICD-10 mental health data by PHS until the ICD-11 can be included in national data collections.

Coding departments will be told how they can access the lookup tool  by PHS Terminology Services at  the end of October. Coders will also be able to contact a national coding advisory helpdesk if they need more advice.

Clinicians

Clinicians should not to use this lookup tool. Instead they should make sure that the appropriate ICD-11 codes are included in their discharge information.