Ouch.
That was my feeling last month, listening to Mel Stride, the Secretary of State for Work and Pensions, at the Conservative Party conference.
Mr Stride said growing social awareness of mental-health problems is itself contributing to a rise in diagnoses and an increase in unemployment.
Figures from the Office for National Statistics for August this year showed that the number of adults with anxiety or depression who are no longer working jumped by 43 per cent to 1.35 million – 386,000 more than before the pandemic.
We are ‘too readily identifying people’ as having mental-health conditions, Mr Stride said. I wonder if he might be right. We may have become too quick to label people as suffering from mental illnesses. While before we might have felt worried, we could now be diagnosed with ‘generalised anxiety disorder’.
We are prescribed treatments (in 2021 to 2022, some 8.3 million people in the UK were on antidepressants, according to NHS data) when our problems may well have social causes such as loneliness or poor housing.
Sir Simon Wessely, a former president of the Royal College of Psychiatrists, agrees. Speaking to the Times Health Commission last month, he said ‘a professionalisation of normal emotions’ meant that children were being treated for problems such as exam stress that could be better dealt with by sport or theatre.
Sir Simon added there were ‘unintended consequences to mental-health awareness campaigns’ which meant problems with relationships or exams ‘have been translated into mental health’. There are now so many possible mental-health conditions that the Bible listing all possible disorders, the American Diagnostic and Statistical Manual of Mental Disorders, runs to 500 pages. The first edition in 1952 was just 100 pages.
This is where it gets personal. I myself have been involved in various mental-health awareness campaigns, as an ambassador for SANE and Rethink Mental Illness. In my thirties, I fell so ill with severe depression that I went to a psychiatric hospital. I wrote a book about it in 2014. It felt good at the time to attempt to dispel some of the undoubted stigma around mental health.
I worry that the dial has swung too far. While the empathy and openness with which mental health is now treated should be welcomed, I also agree with Mr Stride. All the talk about mental health creates a risk that what was once everyday ‘ordinary unhappiness’, in Sigmund Freud’s phrase, is now diagnosed as a mental-health condition. In other words, we are over-medicalising the human psyche.
This matters for several reasons. First, the sheer volume of people who believe the are suffering from mental-health problems means the NHS is overwhelmed with some who may be the worried well, rather than those who really need psychiatric help.
Between 2016-17 and 2021-22, the number of people in contact with NHS mental-health services increased from 3.6 million to 4.5 million people, according to a National Audit Report in February this year.
Secondly, being diagnosed with a mental-health condition often leads to stopping work, even though employment can help our mental health. People often find purpose and value in work.
Economic inactivitity also brings the added stress of financial pressure. I found this to be true myself. I cheered up when I returned to work as a journalist for the Times, thanks to the sense of camaraderie and joint purpose.
What is the answer to the challenge of over-labelling and too much diagnosis? I have resolved to focus less on raising awareness, and more on the need for increased resources for the most unwell.
More importantly, doctors need to have better tools and more time to identify serious mental-health problems. That’s not the same as dismissing the worried well. They are not making up their concerns.
If we are to make sense of who is really suffering, we need to distinguish between mild and more serious conditions, as indeed psychiatrists routinely do when making their diagnoses.
But we don’t have enough psychiatrists to go round for these more nuanced assessments: most of us will have ten minutes with a GP. Figures in 2021 from the Royal College of Psychiatrists show that we have some 4,500 full-time consultant psychiatrists in England for 56.5 million people, or one psychiatrist per 12,567.
Diagnosis should also consider a patient’s circumstances and social situation – what doctors call a ‘psychosocial assessment’, and again something psychiatrists routinely do. Mental suffering can trace its roots back to our upbringing or current social and personal circumstances.
Understanding those circumstances is more likely to lead a more realistic picture of whether someone really has a mental-health problem, or is simply dealing with life’s everyday ups and downs.
Rachel Kelly’s latest book is You’ll Never Walk Alone: Poems for Life’s Ups and Downs (Yellow Kite)
The Oldie January 2024
