The Health Secretary took himself on the weekend politics programmes and decided to tell us “mental health is over-diagnosed” as the hints about this week’s cuts to benefits was trailed. It caused quite the kerfuffle – radio phone-ins, official responses from bodies like the Royal College of Psychiatrists as well as the predictable debates on social media questioning, amongst other things, Wes Streeting’s qualifications to make such a proclamation.
One poster on X (Twitter) asked how someone like a health secretary could go against “science” by raising question about the validity of doctors’ decisions to diagnose someone with, for example, anxiety or depression. Those two diagnoses seemed to be highlighted more often than the others as the example of what is over-diagnoses (albeit I saw few people explaining why they think it is or isn’t the right example to pick).
It got me thinking about various unrelated things –
- “A disorder for everything” – a social media movement, which also led to public meetings, concerning some people’s experiences of the medical system “over-medicalising” normal human experiences after difficult situations. It is obviously fairly normal to experience depression or anxiety after certain negative life events like bereavement or redundancy and for most people that lessens over time. For others, they become chronic and debilitating conditions. Also fair to point out: some of us living with mental health problems hate diagnostic labels to describe what they themselves believe to be human reactions to things like abuse, trauma and incredibly difficult lives most of us can’t imagine.
- 75% of people don’t receive support – I remember Regius Professor Sir Simon Wessely, former President of the Royal College of Psychiatrists, stating as many as 75% of those of us who experience mental health problems don’t seek help or support. This was in the context of him highlighting how awareness campaigns for mental health which encourage people to seek help aren’t always thought through, because we already know help isn’t there for many and the system is under strain – more people seeking help without investment is quite dangerous idea because we can’t help everyone given current levels of resourcing.
- The DSM and ICD classifications – The Diagnostic and Statistics Manual (5th edn) and the International Classification of Disease (112th edn) are the two main ‘bibles’ to list official illnesses, conditions and diseases which come under the broad umbrella term of ‘mental health’. They are difficult books to grasp with, especially for some the US DSM5 – they contain many conditions which would surprise the public and which confound the everyday understanding of mental health, such as “acute intoxication by coffee” or “acute intoxication by alcohol”. Quite a lot of people were mentally ill last Saturday night in UK city centres, it seems and I’m already on my fourth coffee and the day is yet young.
HISTORY & CULTURE
Arguing the Health Secretary is just opposing science doesn’t take in to account how cultural these classification systems are and have been. Until 1974, homosexuality was listed the DSM – presumably that was “science”, if we’re doing the science argument. I wonder what was ‘discovered’ in 1973/4 which saw the removal of that particular mental illness? We’re now in a time where arguments sometimes rage over things like ADHD and please don’t think my using that example means I’m adopting a position on it! – it’s just an example of something which people debate, both in terms of existence and prevalence.
On the one hand, US neurologist Dr Richard Saul has published a book on the topic, summarised quite neatly in Time Magazine “ADHD Does Not Exist”. Editors and sub-editors love catchy, provoking titles: if you read the article, you will see his positioned is nuanced and he helps us understand where documents like the DSM can lead us away from where he thinks we need to be. DSM5 has eighteen different signs and symptoms linked to to ADHD and if you have one of them, you qualify for diagnosis.
Dr Saul himself challenges you to look up the list and see how disturbed you are by finding a number of things which could apply to most people. He goes on to argue we need to look at the signs and symptoms differently, and therefore the whole categorisation of ADHD as an umbrella term for a number of different real conditions which leave people needing help. No doubt there are people who think he’s wrong but you can see from just this paragraph and that article, the potential for public understanding and indeed, doctors’ understanding, to differ.
DO WE OVER-DIAGNOSE?
Almost certainly, yes – we also under-diagnoses, mis-diagnose and don’t-diagnose. Who the hell knows how to untangle and aggregate all of that whilst we continue to maintain a system of public support for those who, amidst it all, can’t work to support themselves or who become embroiled in the criminal justice system, for example? What that all means for politics is for politicians but these debates about the number, the extent and even the validity of diagnoses do become live issues for the criminal justice system as well, manifested most obviously in the “mental health card” debate where some people who offend are accused of “playing” the card to get out of criminal liability for appalling things they have done.
I suspect, like crime, the benefits system will involve an element of that – you’d have to be naive to think otherwise, but also like crime, my experience of it all is it tends to be something where there is just the need to check and ask reasonable questions. Not everyone who offends whilst mentally ill is absolved from criminal responsibility, just like many people who live with mental health problems can and do work. In fairness, my own journey in to learning about mental health involved me hearing an endless line of mental health professionals pointing out one of the best things you can do for many patients is ensure they have a job – because it provides routine, structure, socialisation and something people can feel proud of doing (assuming it’s a reasonable quality job and people are not being exploited, of course).
Yes, some people may need some support to achieve that, but don’t we all from time to time?
I’m not sure Wes Streeting is necessarily wrong, but he’s not right either and his decision to only highlight one narrow aspect of a wider, more complicated discussion is where he put the metaphorical target on his own back and invited people to shoot at him.
Winner of the President’s Medal, the Royal College of Psychiatrists.
Winner of the Mind Digital Media Award
All opinions expressed are my own – they do not represent the views of any organisation.
(c) Michael Brown, 2025
I am not a police officer.
I try to keep this blog up to date, but inevitably over time, amendments to the law as well as court rulings and other findings from inquests and complaints processes mean it is difficult to ensure all the articles and pages remain current. Please ensure you check all legal issues in particular and take appropriate professional advice where necessary.
Government legislation website – www.legislation.gov.uk
Mental Health Cop 