Experiencing stress in life is not a disease - GPs discuss mental health over-diagnosis

Many general practitioners (GPs) in England have expressed concern that mental health disorders are being over-diagnosed, according to feedback shared with the BBC. A recurring opinion among family doctors is that society often over-medicalizes the normal challenges and stresses of life. However, these professionals also raised alarms about the difficulty patients face when seeking adequate mental health support.

Earlier this week, the Health Secretary initiated an independent review to investigate the growing demand for mental health, ADHD, and autism services in England, aiming to identify any gaps in care.

Over 5,000 GPs were surveyed by the BBC, with more than 750 participating in the study. The responses revealed significant concerns about both over-diagnosis and the lack of appropriate care. Among the 752 GPs who took part in the survey, 442 believed that over-diagnosis was an issue, with many indicating that mental health conditions were diagnosed too frequently, although not always to a large extent. On the other hand, 81 GPs felt mental health issues were often under-diagnosed.

Aside from over-diagnosis, many GPs were troubled by the insufficient mental health support available for their patients. One GP commented, Life being stressful is not an illness, reflecting the sentiment that emotional struggles such as grief or heartbreak are part of normal life. Another GP argued that labeling emotional difficulties as anxiety or depression over-medicalizes these issues, diverting resources from patients with severe conditions.

Some GPs were more critical, describing certain patients as dishonest, narcissistic and gaming the system for free services. However, the majority were focused on the systemic problems surrounding mental health care.

According to NHS England, one in five adults in the country reports a common mental health issue like anxiety or depression, with the rates higher among younger people, particularly those aged 16-24. Many GPs identified 19-34 year olds as the group most in need of mental health support. Several attributed this to a decline in resilience among young adults since the COVID-19 pandemic, with some patients more interested in receiving a diagnosis than developing coping mechanisms.

However, other GPs emphasized that under-diagnosis was also a critical problem. Some pointed out that patients needed encouragement and support to cope with lifes challenges, while others noted that services were hesitant to conduct thorough assessments or diagnoses.

Nearly all GPs surveyed reported an increase in the time spent on mental health cases over the years, primarily due to the lack of quality mental health services and the pressure from patients who believe they have mental health problems when they are simply facing everyday difficulties like housing or financial struggles.

Earlier this year, Health Secretary Wes Streeting made remarks to the BBC suggesting that mental health conditions were being over-diagnosed and that too many individuals were being written off. However, he later revised his statement, acknowledging the complexity of the issue. Currently, there are thought to be around 2.5 million people in England with ADHD, many of whom remain undiagnosed, while some NHS services for ADHD have closed to new patients due to overwhelming demand.

Feedback from patients indicates that accessing proper care and support is becoming increasingly difficult. A majority of the GPs in the survey, 508 out of 752, reported that quality mental health care for adults was rarely or never available in their area. Moreover, 640 GPs expressed concerns about the availability of mental health services for young patients. One GP described the lack of support as a national tragedy, and another said that children literally need to be holding a knife to be taken seriously by mental health services, which often disengage as soon as the immediate crisis is over.

Many GPs admitted to prescribing medication, such as antidepressants, to patients due to concerns that they wouldnt be able to access other treatments like talking therapies in a timely manner. Of the 447 GPs who responded, the majority confirmed that they often resorted to prescribing medications, even though they knew that such treatment may only offer short-term relief.

Professor Victoria Tzortziou Brown, Chair of the Royal College of GPs, highlighted the delicate balance family doctors must strike when patients expect a mental health diagnosis that doesnt meet the clinical criteria. She emphasized that we must be careful not to medicalize the full range of normal feelings and behaviors, while also cautioning against dismissing genuine mental health concerns as over-diagnosis.

The independent review into mental health service demand is set to consider all the evidence and deliver recommendations aimed at improving the system and providing genuinely useful guidance for future mental health care policy.

Author: Riley Thompson