‘Labour’s mental health review needs to reframe overdiagnosis’ – LabourList

We’re having the wrong debate about mental health diagnosis.

Following Wes Streeting’s announcement of a review into the factors behind increased diagnosis of mental health conditions, ADHD and autism, healthcare professionals and wider society are divided over whether mental health conditions are being overdiagnosed or underdiagnosed. 

This debate misses the fundamental issue – we’ve created a system which has medicalised access to basic psychological tools. The question shouldn’t be whether we’re diagnosing too much, but why accessing support requires clinical intervention in the first place.

Divided opinion

Opinion in this debate is deeply polarised. Over half of GPs surveyed by BBC News believed mental health conditions are being overdiagnosed, with concerns about ‘over-medicalising life and emotional difficulties’, and the view that ‘life being stressful is not an illness’, while others argued the real issue was underdiagnosis, and that “people need to be accepted, helped and encouraged to live life”.

READ MORE: ‘From maternity to inequality: evidence, consultation and context must be at the heart of the independent review into mental health’

Predictably, there are staunch views on both sides in wider society too. Mind warns of a ‘paradoxical increase in cynicism about mental health…with claims of overdiagnosis’, while Spiked argues that ‘redefining everyday problems as mental-health conditions is driving a generation of Britons to despair’, and that young people ‘have been raised to interpret normal human emotions and experiences…as pathologies’.

Labour’s review should reframe this entirely, asking why isn’t there more support outside of clinical settings to manage life’s challenges?

My experience

This isn’t simply an outsider’s view. Aside from spending over a decade working in healthcare policy and education, I’ve been a mental health service user. I’ve experienced varying levels of support from primary mental health services – especially cognitive behavioural therapy (CBT) through to talking therapies.

I benefited from clinical support for some of the challenges I experienced, and clinical pathways remain essential for many cases – including when people have serious mental illnesses or complex needs. But much of what I learned were techniques that should be universally accessible. Anyone familiar with CBT will have learned some of the many strategies available for managing emotions – including tools to help people analyse worries, and reframe negative thoughts and feelings. These techniques are widely used to help millions of people – with almost two million people accessing CBT in the UK in 2021. 

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The mistake the cynics make is to assume that most of those people didn’t need this CBT support, because their diagnoses aren’t valid. I’d flip this on its head: if people need support to manage their emotions, why do they have to wait weeks or months and then enter a clinical pathway in order to access it?

 Challenging the system

Of course, there are CBT resources available online and ways to access support outside of these pathways. But how aware are people that this is the case, and that these resources might help them to manage their emotions without the need for a clinician’s input?

This lack of awareness is partly driven by the overdiagnosis debate itself. Critics who claim that there is overdiagnosis often also dismiss mental health challenges, and thereby contribute to the stigma surrounding them. This prevents conversation and discourse that could normalise these emotions and challenges and make people much more aware of strategies and resources that could help them.

It’s encouraging that there is widespread support for the government’s review, including from Mind and the Royal College of Psychiatrists. Crucially, the scope of the review will include ways to ‘promote the prevention of mental ill health’ and ‘create resilience’. This government has a real opportunity to reframe mental health discourse and support, and it’s important this is done in a way that is true to Labour values. The review must not contribute to the stigma surrounding mental health, but nor will it suffice for it to reinforce the status quo. 

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Instead, part of its impact must be to empower people to manage their emotions without the need for clinical pathways and waiting lists. Ensuring that people have access to coping strategies and tools for building resilience early would reduce demand on mental health services – freeing up precious clinical support for those who most need it, and helping millions of people navigate challenges without reaching crisis point. This is Labour’s opportunity to fundamentally reshape how we think about mental health support in the UK.

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