Over diagnosis and stigmatisation
are what Wes Streeting has been accused of
Wes Streeting, the UK Health Minister (and MP hungriest for Keir Starmer’s job) has attracted negative press for an interview with the BBC on 13th March. The headlines suggested that Wes thinks too many people are claiming mental illness as a reason not work.
Headlines schmedlines. What he actually said is below.
“Here’s the other thing, mental wellbeing, illness, it’s a spectrum and I think definitely there’s an overdiagnosis, but there’s too many people being written off and, to your point about treatment, too many people who just aren’t getting the support they need. So if you can get that support to people much earlier, then you can help people to either stay in work or get back to work.”
I think it’s worth breaking this down.
‘it’s a spectrum’
My experience of anxiety/low mood is not necessarily your experience and a meaningful conversation about mental health provision needs to recognise this.
Many, many people manage anxiety and depression whilst going to work or school, raising children and generally making their life function. Many other people are so traumatised or depressed that getting up and showering is a big win. These two ends of the spectrum and everything in-between are all valid, and support/treatment should be according to need, not the diagnosis.
‘I think definitely there’s an over diagnosis’
Anxiety and depression or a mixture of the two are the most commonly diagnosed mental health conditions in the UK and screening tools such as the GAD7 for anxiety and PHQ9 for depression are generally used to assess the extent of both. You can find the GAD and PHQ all over the internet, you may be given them by your GP and if you come and see me, I’ll ask you to complete them before our first session.
These tools give an indication of your mood in the moment of completion and your GP may use the results to refer you to talking therapy. I will take a passing glance and note the level but it won’t affect how I seek to help you, In other words it gives me an indication of where you’re at before I meet you, but it’s the first session I’m really interested in to learn about you.
There are other screening tools available and anyone with a passing knowledge of google can diagnose themselves with a whole range of conditions.
So, what of that diagnosis? In the vast majority of cases it doesn’t lead to a prescribed treatment plan or medication regimen. It’s not like treating a physical illness with the most appropriate anti-biotics, but more of a let’s try this and if it works great, if not we’ll have a rethink. It can take months to find the right drug and dosage. Therapy similarly doesn’t come with a timeline (well, it might be limited, that doesn’t mean the number of prescribed sessions correlates to need).
So yes, Wes may well be correct that there is an over diagnosis of anxiety and depression at least, but the reality is that a diagnosis is often less important or perhaps irrelevant in the face of treatment scarcity.
‘too many people who just aren’t getting the support they need’
It is impossible to argue with this statement and the under resourcing of NHS mental health provision goes way back.
Thatcher closed many psychiatric hospitals in the 1980s moving patients to the euphemistically titled Care in the Community. This policy annihilated inpatient provision (I was going to write treatment, but I really don’t know what went on back then). In this century inpatient beds have similarly fallen1 from almost 52,000 beds to a low point of 24,000 in 2022. The trend has started to creep upwards but is, and will continue to be, woefully short for years to come.
This is purely anecdotal, but I have on more than one occasion called local community services about actively suicidal people, under their care. Not once have I been able to speak to a human, but have had to leave voicemails. In none of these situations have I, or the person at risk, received any kind of response from these services.
No response AT ALL.
I am sure this is a factor of under resourcing and burnt out staff, but let’s be upfront about this and stop suggesting that it in any way represents a service. It is families who pick up the short fall and as mental ill health and family breakdown are often related, it is by no means certain that there is a family capable of doing this.
We make life harder for the NHS by not providing help where it is needed, and kicking the problem down the road. There are 100 rehab inpatient beds in the NHS, In the year April 21 - March 22, there were 289,215 people in contact with drug and alcohol services. That is over a quarter of a million people who have come forward to ask for help with their addiction, and 100 beds between them. Those addiction issues have a massive knock on effect on A&E services and inpatient admissions for alcohol related diseases. And that’s without the behavioural addictions.
‘help people to either stay in work or get back to work’
Hmm, this is interesting. This kind of supposes that work is a place that feels safe for someone with a mental health condition.
I know there has been a substantial push around mental health in recent years, and I hear a lot about mental health first aiders and wellness policies being drawn up. But I also hear from employees who nonetheless, feel unable to ask for support. It is still easier in most cases, to ask for time off for an outpatient appointment than a therapy session.
Similarly, not every workplace feels like the kind of environment that a neurodivergent diagnosis can be safely disclosed. Which means that adjustments can’t be asked for and the individual has to carry on masking, adding stress to what is an already difficult situation.
Despite the fact that people still aren’t going to the office 5 days a week, and the brief that wfh is effectively skiving, I still hear about presentism and a culture that encourages burn out.
Yes, this is ancedotal and I’m aware my cohort is skewed but even so, alongside getting people fit to work, I think we could usefully focus on getting work fit for people.
The NHS is in a perilous state, decades in the making, and turning it around will also take a long time. But, we do have to be honest about the realities of the situation, and the need for a nuanced solution.
Let me know what you think, particularly if you have experience of mental health provision and especially if you have a helpful and supportive employer. We need to champion the trail blazers.
https://www.statista.com/statistics/473278/number-of-psychiatric-care-beds-in-the-united-kingdom-uk/
Johanna, Thanks for breaking down this attention-grabbing statement. I agree. Streeting's statement, plus the PM's abolition of the NHS England Quango plus Kendall's DWP announcements yesterday about the benefits overhaul, are all causing much anxiety.
The one thing they all have in common is, 'It is families who pick up the short fall'.