With the 80th anniversary of VE-Day coming up in May, have we lost the press-on resilience that helped with the Second World War? Health Secretary Wes Streeting seems to think so. Over the weekend, he faced a backlash from charities after claiming there was an over-diagnosis of mental health conditions with too many people being “written off”.
Mental health charity Mind warning it was important to be “extremely careful” with the language around diagnoses to avoid stigmatising people. Another charity, Rethink Mental Illness, responded that pressures in the system created a “tremendous struggle” for people with long-term illnesses to get diagnosed. “The crisis in the nation’s mental health is very real,” the deputy chief executive of the charity declared.
The Health Secretary was clearly alive to the upset in the mental health lobby his comments were going to stir up, so he went on to say that there were “too many people who just aren’t getting the support they need”, then highlighted the Government’s pledge to recruit 8,500 more mental health staff to cut waiting lists.
To a psychiatrist, this looks a bit like the Minister is suffering from some kind of ‘split personality’. If there is over-diagnosis, too many people are being diagnosed who haven’t really got a condition. Yet if you are recruiting more mental health staff to cut waiting lists, surely you’re offering treatment to people who weren’t really ill in the first place?
So what is the truth? Well, one certain diagnosis is that this country cannot afford to sustain the escalating costs of the recent bloating of the health-related benefit bill, and caseload, in particular for mental illness. The Treasury’s bill for health and disability benefits, which was £28billion in the year before the pandemic, is now £52billion a year and forecast to hit £70billion by the end of the decade.
Between 2002 and 2024, the number of 16 to 64-year-olds claiming disability benefits for mental or behavioural health conditions increased from 360,000 to 1.28million. Roughly 11 million ‘fit notes’ are issued by GPs every year in England alone – with 93% ruling the patient as “not fit for work”. That has doubled over a decade.
But there is no blood test for mental illness. Therefore, any diagnosis is a clinical judgement call. Hard-pressed GPs want to get patients through their clinics as soon as possible. There is a huge set of incentives built into our NHS and welfare system to give those who claim they are ill, what they want; an official stamp of approval that, congratulations, you have achieved a psychiatric disorder.
To a qualified psychiatrist like myself, correctly diagnosing someone who really is suffering from a mental illness should help them. But getting the diagnosis wrong can be as catastrophic for that individual as missing the diagnosis.
Telling people who are merely unhappy that they have depression means they start identifying themselves as disabled, and so the diagnosis becomes handicapping, not liberating. It becomes a self-fulfilling prophecy. It allows many to blame an illness for the normal difficulties of life and shifts responsibility to the state to cure them.
There is now a perverse incentive to be mentally ill rather than well, amongst the many modern benefits, it gets you sympathy, extra time in exams and more lenient marking, it allows you sick days away from your boring job and it even forces your employer to alter that job so it becomes less stressful.
But the more you are insulated from difficulty, the more this system conspires to prevent you learning how to become resilient in the face of the “slings and arrows of outrageous fortune,” as William Shakespeare put it.
Throughout history, it was widely understood that it is inherent in life itself that there is strain and upset. The better answer to life’s stresses was also understood by Shakespeare, in an era where there were no psychiatrists, and this was to “take up arms against a sea of troubles”.
You could place the blame for our current epidemic of over-diagnosis at the door of the consulting room of Sigmund Freud, the founder of psychoanalysis. But he famously declared that the goal of therapy was the transformation of “neurotic misery into common unhappiness”.
If anything, over-diagnosis does a disservice for the many who really are suffering from psychiatric disorders. It diverts resources away from them and, in some cases, has made mental health a voguish badge to be brandished for public sympathy.
Wes Streeting needs to get over his phobia of stating the blindingly obvious. Being merely unhappy doesn’t mean you are mentally ill and require formal treatment. But today our government seems to need a psychiatrist to tell them the correct prescription: that a job is often the best medicine.
Dr Raj Persaud is a Harley Street Consultant Psychiatrist and author of The Mental Vaccine for Covid-19, published by Amberley
