How to stop over-medicalising mental health

The importance of good mental health is a cause vigorously championed by everyone from the Princess of Wales to the leader of the opposition, Sir Keir Starmer; Employers preach the gospel of wellness. Britons were once encouraged to hide their feelings; They are now urged to seek support.

Much of the rich world has struggled with rising rates of self-reported mental health problems, particularly since the Covid-19 pandemic. But the figures in Britain are alarming. Around 4.5 million Britons were in contact with mental health services in 2021-22, an increase of almost 1 million in five years. In the last decade no other European country has seen a greater increase in the use of antidepressants.

An NHS survey in 2023 found that one in five young people aged 8 to 16 in England had a probable mental disorder, up from one in eight in 2017. In young people aged 17 to 19 , the figure had increased from one in ten to one in four. The number of unemployed people with mental health problems has increased by a third between 2019 and 2023.

It’s good that people don’t feel like they have to hold back and that suffering from mental illness is real. Mental health awareness has reduced the stigma of some illnesses and revealed that the needs of many Britons are unmet. But awareness has also caused damage.

For all their good intentions, awareness campaigns are leading some people to conflate normal responses to life’s difficulties with mental health disorders. Special treatment creates incentives for people to seek diagnoses and medicalize problems unnecessarily. The need to treat people with milder illnesses compete with care for those who have the most serious ones.

Start with the idea that mental health has become an all-encompassing term. The large proportion of people who say they have a disorder is a warning sign. Around 57% of university students say they suffer from some mental health problem; More than three-quarters of parents with school-age children sought help or advice about their child’s mental health in 2021-22.

In surveys, Britons increasingly describe pain and stress as mental illnesses, redefining how the illness is understood. Most diseases do not yet have objective biomarkers, so self-reported symptoms weigh heavily in official statistics and diagnostic processes.

People have incentives to label mild forms of distress as a disorder. In 2022, more than a quarter of 16- and 18-year-olds in British schools were given extra time in official exams due to a health problem. Evidence of a mental health problem can unlock welfare payments. Certification does not need to come from an NHS doctor – many private clinics are ready to provide it.

Companies may prefer to label stress as a disorder rather than deal with the consequences of recognizing that working conditions are poor (the World Health Organization suggests that good management is the best way to protect mental health in work place). The highest rates of diagnosed depression occur among the poorest in England, but the government would probably prefer prescribing antidepressants to trying to solve poverty.

Medicalizing mild distress may not benefit patients. A study of mindfulness courses in 84 British schools found that regular teaching was just as good for mental health. But the great harm of overdiagnosis is to those who need help most.

The NHS can, in theory, classify patients according to their needs. In practice, a service that has long been understaffed and poorly organized is struggling with growing demand. The number of young people in contact with mental health services has expanded to more than three and a half times the workforce rate in child and adolescent psychiatry. A 22% increase in the overall mental health workforce in the five years to 2021-22 could never have matched a 44% increase in referrals for all patients. At least 1.8 million people are waiting for mental health treatment.

Growing demand is driving staff into private practice. Doctors exhausted from dealing with the NHS’s most serious cases can earn up to £1,000 ($1,265) per session carrying out attention deficit hyperactivity disorder assessments. The NHS has just 6% more consultant psychiatrists than a decade ago, compared to 86% more consultants in emergency medicine.

The police pick up some of the pieces (officers in England spend around a million hours a year with mental health patients in accident and emergency departments), but that is not treatment. Even as awareness of mental health conditions increases, outcomes for people with serious mental illnesses, such as bipolar disorder and schizophrenia, are worsening; They die 15 to 20 years earlier than the rest of the population, a gap that was widening before Covid-19 and was exacerbated by it.

Rethinking the British approach to mental health requires several changes. More money should go into research so that people receive the right treatment; Mental disorders absorb 9% of England’s health budget, but 6% of medical research funding. The social causes of mental illness should also receive more attention. Earlier this year, the government shelved an ambitious plan to analyze the underlying context of mental disorders, from poverty to isolation; That plan should be reactivated. More time and effort should be dedicated to those who need help most; Reforming the Mental Health Act, an outdated law that leaves the mentally ill feeling like criminals, would be a start.

Causes and effects

Above all, Britain needs to avoid the mass medicalisation of mild forms of discomfort. Funneling people into an overburdened health care system is having predictable effects. All suffering should be taken seriously, but a diagnosis is not always the best thing for someone; Recent research found that volunteers were happier when they learned to suppress negative thoughts. Britain has become more compassionate towards mental health. It is also necessary to become more reflective.