The obsession with 'overdiagnosis' is a much bigger problem than overdiagnosis itself
The health secretary openly condemning 'overdiagnosis' of mental health and neurological issues shows just how skewed and hollow the discourse around them really is. And this helps nobody.
I’m repeatedly on the record as saying that mental health awareness is all well and good, but not an end in and of itself. Because it’s always going to be of very limited use if not accompanied by mental health understanding, and mental health action. I literally wrote a book about this.
And now, with the grim inevitability of watching and erosion-beset coastal town sliding slowly into the sea, we’re seeing the result of a society-wide effort to champion awareness of mental health and neurodevelopmental problems, and absolutely nothing else.
Most obviously, the UK health secretary Wes Streeting’s insistence that “too many people have been written off” by an “overdiagnosis” of mental health problems.
There’s a whole suite of problems here. Like how someone receiving a mental health diagnosis in no way, shape, or form “writes them off”.
For instance, there’s the much touted statistic that “1 in 4” adults in the UK, 25% of the adult population, will experience a diagnosable mental health problem in any given year.
The current employment rate is roughly 75%. So, unless literally every single one of the 15 million people in the UK with a diagnosed long-term physical condition are gainfully employed, many who are officially ‘mentally unwell’ are gainfully employed.
However, the health secretary is just the tip of a very large, noxious iceberg, made up of mover and shakers who define policy, coverage, and discourse, who all seem eager to dismiss the plight and needs of those who require mental health help and support.
Most recently, with claims of ‘overdiagnosis’, whether of mental health issues, neurodevelopmental disorders like ADHD, or any other variation.
But, do they have a point?
Is there actually an ‘overdiagnosis’ problem?
Countless people refer to ‘overdiagnosis’ as an established fact. However, the actual data concerning mental and neurodevelopmental issues is far from so clear.
The medical community is very divided. Some say there’s overdiagnosis, others say there’s underdiagnosis, others say something else is going on.
The Independent has published a very thorough article on this, which is worth checking out. But one intriguing element flagged up is that, while rates of mental health diagnoses have been relatively stable for years, the number of people accessing mental health services has increased dramatically in the last 5 years.
Remember, 5 years ago was that whole ‘pandemic’ thing, which traumatised all of society for about 2 years1. One would assume that would have caused a lot more people to need help with mental health.
Inevitably, the costs for mental healthcare have gone up considerably as a result. Presumably this is the root cause of the narrative that ‘overdiagnosis’ is a problem?
Personally, I’d contend that money now being spent on mental healthcare is a long-overdue corrective, to what we should have been spending on it all along But in truth, the data around rates of mental health issues are notoriously difficult to derive any clarity from.
This is often because diagnosis is a messy process. Different doctors can interpret ailments in different ways. Someone with combined anxiety and depression could appear in the stats twice. The impact of things like ADHD are often mistaken for depression, and other more mental ailments. And so on.
But even overlooking all that, the ‘overdiagnosis’ claim, in the context of policy and national interest, remains dubious.
Because it suggests that there is a specific number/rate of mental health and neurodevelopmental disorders that should be occurring within the population, and the present number is higher than that.
How would you even determine such a thing? What is the “right” amount of diagnoses we should be seeing? And why?
This isn’t to say that overdiagnosis definitely isn’t a problem that’s affecting national budgets. But you’d need abundant evidence showing that this is the case, before you could morally justify framing a media discourse/national policy around it. And such evidence simply isn’t there.
And yet, here we are.
Is overdiagnosis happening at all?
Are there people who are being diagnosed with a mental or neurodevelopmental issue, when they shouldn’t be? Almost certainly.
It’s unavoidable. When there’s a system in place to help people, some will always try to exploit it. It’s just how humans work. And some will succeed.
Particularly with an issue as ‘subjective’ as mental health. Indeed, trying to treat mental health problems via a purely objective, standardised process has been shown to be unworkable. It’s really important, with mental and neurodevelopmental issues, to include the individual’s perspective.
However, this means personal perspectives can dominate. Particularly in the social media realm, where influencers and personal testimonies are a default source of information for many.
Unfortunately, the relative absence of regulation means misinformation about mental and neurodevelopmental problems is rife. And if people, particularly less-experienced young people, are worried about their own mental health, and defer to such sources, you’ll end up with people seeking a diagnosis when they probably shouldn’t be.
That must be it! It’s the young people, and the social media. What else could it be?
It couldn’t be that mental health genuinely is declining due to an endless bombardment of society-wide crises.
It couldn’t be that a health service stretched micrometre-thin by cuts and mismanagement often results in harassed GPs having 10 minutes to diagnose and treat someone who’s been dealing with a baffling psychological crisis for months, and only just now manged to make it to an appointment.
More cynical doctors may dismiss such cases, but others could well conclude that it’s better to do something than nothing, and prescribe antidepressants.
Speaking of, all these people getting diagnoses for ADHD etc. from private firms? Firms who will likely want to give people what they pay for? Surely they’re an obvious cause of overdiagnosis?
Maybe. Or maybe it’s because, given the aforementioned cuts and overstretchedness, an official NHS diagnosis can take longer than the lifespan of the typical guinea pig. And if someone’s been dealing with unrecognised and untreated ADHD right up to adulthood, and only now decides they need help? Their functionality is probably running on fumes already. Enduring it for another 5+ years probably isn’t a feasible option.
Basically, for a lot of people, the choice is either “Go private” or “Suck it up, bi*%h!”
But yes, overdiagnosis due to phones and trends is the only obvious conclusion.
My point is, people being diagnosed when they shouldn’t be? Sure, that can, and almost certainly does, happen.
Is it a problem that’s affecting the outcome of the world’s sixth largest national economy? I’d eat
This is what mental health awareness looks like! GaaaaaH!!
THOSE IN POWER: “It’s important to be kind. And considerate. Mental health awareness is important”
THE POPULATION: “We’re now aware that we have a lot of mental health issues”
THOSE IN POWER: “NOT LIKE THAT!!”
That’s basically what’s happening here, isn’t it.
If you spend numerous years promoting a national awareness of mental health, and encouraging people to “reach out” and “seek help”, then eventually, they’ll… do that.
And what happens when they do? What becomes of all this talk of consideration and kindness and help? Maybe it’s hiding in the shadow of this OVERDIAGNOSIS narrative.
Because actually addressing the mental health and neurodevelopmental needs of a complex and ever-growing population? That requires effort. Investment. Time. Things which seem to be in perpetual short supply, lately.
True, genuinely addressing the mental health needs of a population would be a big ask at the best of times, let alone times seemingly tailor-made to constantly stress out and traumatise as many people as possible.
But for the response of so many to be saying “A lot of you are probably lying about being unwell, actually”? There’s no evidence based justification for that. And thus, there’s no moral one either.
Especially because so many mental health issues will be connected to government policies, decisions, and cuts. It’s like introducing a law that bear traps must be placed outside every supermarket, then declaring that too many people are needing ankle reconstruction surgery.
And let’s be frank; if someone were to do a Venn diagram for “People who complain about overdiagnosis” and “People who have actually gone through the process of actually getting a diagnosis”, it would just be two distinct, separate circles. One circle on the leftmost side of the paper, and the other on the other side. Of the Pacific ocean.
Most who write about overdiagnosis seem to believe that getting a diagnosis is a simple process, like buying hard spirits with a fake ID. Drawn in crayon.
In reality, it’s a reliably arduous, labyrinthine process. One hesitates to say it’s actively designed that way to deter the most vulnerable from accessing the (costly) help they need. But only because I can’t actually prove that. And legal fees are similarly costly.
One would also hesitate to say that political and commenter types clutching their metaphorical pearls about overdiagnosis and ‘medicalisation’ are being unwittingly hypocritical, given how they’re just putting a medical spin on the classic “benefit scroungers” riff.
Because the overdiagnosis narrative is just another version of “A lot of people are claiming the help they’re legally and morally entitled to, but it’s possible that some of them don’t actually need it, so they’re ALL suspect!” A conclusion held and propagated by people who have never needed that help, and are wealthy and pampered enough to ensure they never will. And yet somehow hate anyone else being given something they haven’t actively laboured for. Tale as old as time…
And it’s endlessly telling that, once again, this “Do these people really need all this expensive help?” attitude is applied to the most vulnerable. By comparison, while a much of the UK budget is spent on mental healthcare, roughly ten times as much is spent on pensions.
But last I checked, no pundits or columnists ever say “Are all these people really that old?”
Granted, age is an easily quantifiable quality, while mental health is not. But if saving money is so important, why not question whether so many people, in an era of ever-increasing longevity and health, really need a pension?
It’s not because pensioners tend to be wealthy homeowners who vote in large numbers, surely? That would be silly!
Ultimately, the nebulous and uncertain nature of mental/neurodevelopmental issues make them an easy target for people who have never encountered them, but need a scapegoat for the problems afflicting society. Which are often ones that they thoughtlessly helped create.
Basically, it's just making things ever harder for people whose lives are undoubtedly hard enough already, for no good reason at all.
Consider buying my book, Why Your Parents Are Hung-Up on Your Phone and What To Do About It
If you assume COVID-19 has gone away now, which many people would argue is not the case. And with good reason.
I think the section "Is it a problem that’s affecting the outcome of the world’s sixth largest national economy? I’d eat..." must have been truncated? My hat? My shorts? Otherwise, excellent article.