Are mental health conditions overdiagnosed in the UK?

Mental Distress is Under-Diagnosed – But Over-Medicalised

Susan McPherson, Professor in Psychology and Sociology, University of Essex

A year ago, the UK’s then prime minister, the Conservative Rishi Sunak, announced that “sick note culture” had gone too far. His work and pensions secretary claimed that “mental health culture” had gone too far.

These statements merged concern about affordability of disability benefits with ideas about overdiagnosis of mental illness. This appeared to be in response to a report from the Resolution Foundation, a thinktank.

Undiagnosed Distress is a Bigger Problem than Overdiagnosis

A recent study using the UK Longitudinal Household Study found that 12 times as many people in the “undiagnosed distress” category (with severe symptoms but no diagnosis) than the overdiagnosed category.

The study also identified significant inequalities. People living with a disability had nearly three times the risk of undiagnosed distress compared with people without a disability. Women had 1.5 times the risk of undiagnosed distress compared with men. Lesbian, gay or bisexual people were 1.4 times more likely to have undiagnosed distress compared with heterosexual people. People aged 16-24 had the highest risk compared with all other age groups.

A Mental Health Diagnosis is Just a Label – and Usually an Unhelpful One

Joanna Moncrieff, Professor of Critical and Social Psychiatry, UCL

There has been a dramatic escalation in the number of people seeking treatment for mental health problems in recent years. In the year from April 2023 to 2024, 3.8 million people were in contact with mental health services in England alone, which is 40% higher than before the COVID pandemic.

A Diagnosis is Not an Explanation

A mental health diagnosis doesn’t explain anything. It is simply a label that can be applied to a certain set of problems. The process by which this label is conferred is not scientific or objective and is influenced by commercial, professional, and political interests.

Unhelpful Consequences of Diagnoses

Giving people with mental health problems a diagnostic label often leads to ineffective and often harmful medical treatment. It also misses the actual problems. Being diagnosed often leads to being prescribed a psychiatric drug, such as an antidepressant. About 8.7 million people in England now take an antidepressant, half of them on a long-term basis.

Prescriptions for other drugs, such as stimulants (prescribed for a diagnosis of ADHD), are also rising fast, even leading to medication shortages. Yet the evidence that any of these drugs improve people’s wellbeing or ability to function is minimal.

Conclusion

Mental distress is under-diagnosed, but over-medicalised. Reducing over-medicalisation doesn’t necessarily mean fewer services. What we need is different services that provide appropriate support for people’s actual problems, not treatment for medical labels. We also need ways to excuse people from responsibilities when necessary, without making them feel like they have to take on a “sick” role that implies they are forever ill and helpless.

Frequently Asked Questions

Q: What is the difference between over-diagnosis and over-medicalisation?
A: Over-diagnosis refers to the act of diagnosing a condition when it does not actually exist, while over-medicalisation refers to the excessive use of medical treatment and medication for a condition that does not require it.

Q: Why is over-medicalisation a problem?
A: Over-medicalisation can lead to the unnecessary use of medication, which can have serious side effects and health risks. It can also create a dependency on medication and lead to a lack of understanding of the underlying causes of a condition.

Q: How can we reduce over-medicalisation?
A: We can reduce over-medicalisation by providing alternative forms of support and treatment, such as therapy and counseling, and by increasing public awareness of the importance of mental health.