Fleiss`Kappa was used to examine the diagnostic agreement between the four clinicians. We found that the match was good both for each diagnosis/no diagnosis, as well as for the diagnostic categories of emotional diagnosis, ADHD/hyperkinetic diagnosis, and comorbidity. For the behavioural diagnosis category, agreement was excellent (Table 1). The limitations of this study should also be taken into consideration. Due to the impossibility of obtaining additional or subsequent information and the problem of circulation between individual clinician assessments and consensus diagnoses, the consensus procedure could not be used to validate diagnoses and severity assessments. Such procedures are imperfect, but nonetheless valuable, as the assessment of mental health remains based on developmental history, behavioral observations, and reported difficulties in daily life [3-6, 41]. The use of a single expert rating may not always be sufficient to establish reliable diagnoses . The consensus debate has the advantage of providing intelligent contributions from several experts to refine the final diagnosis. Nevertheless, in some cases, additional information or a longitudinal cross-section may have further refined the diagnosis than a consensus debate.
It is also questionable whether the assessment of young children for whom the DAWBA interview is not applicable poses different challenges to the validity of a web-based interview or whether the information provided by parents and teachers is sufficient. In order to assess the validity and accuracy of diagnoses and severity assessments, a study design in which clinicians would examine patients using traditional methods such as a clinical interview would have been more appropriate. In summary, the information obtained with DAWBA online can provide a solid foundation for reliable clinical diagnoses and assessments of the severity of common mental disorders in a clinical setting. Clinical practice that includes systematic classifications independent of diagnosis and severity is preferable to severity assessments because of the resulting improvement in reliability. Protocols and procedures must be put in place to move people from emergency, psychiatric, detoxified and residential settings into a safe community environment. The CCHC should establish protocols and procedures, including the transmission of medical records related to services received; active post-operative care after dismissal; where applicable, a suicide prevention and safety plan; and a provision for peer services. Procedures should include a short period of time between subsequent assessment and treatment. Next comes the renewed mandate for NHS England, which contains a new requirement for the NHS that “every municipality has plans to ensure that no one is left out of health services in the event of a mental health crisis”. . . .