How to stop the overmedicalization of mental health

The importance of good mental and physical health is a passionate cause championed by everyone from the Princess of Wales to Opposition Leader Sir Keir Starmer, with employers preaching the happiness gospel. Where Britons were once encouraged to hide their feelings, they are now urged to seek support.

Many developed countries are suffering from rising rates of self-reported mental health problems, especially since the COVID-19 pandemic. But the UK figures are alarming: Around 4.5 million Britons received mental health services in 2021-22, an increase of around one million over five years. No other European country has seen such a large increase in antidepressant use over the past decade.

A 2023 National Health Service (NHS) survey found that one in five eight- to 16-year-olds in England are suspected to have a mental illness, up from one in eight in 2017. For 17- to 19-year-olds, the figure rises from one in 10 to one in four. The number of people unemployed because of mental illness is set to increase by a third between 2019 and 2023.

It’s good that people don’t feel like they have to bottle up their emotions, and that the suffering of mental illness is real. Increased awareness of mental health has helped to destigmatise some illnesses and highlighted the unmet needs of many Britons. But increased awareness has also done some damage.

Although well-intentioned, awareness campaigns lead people to confuse mental illness with normal responses to life’s difficulties. Special treatment creates incentives for people to seek diagnosis and unnecessarily medicalize problems. The need to treat those with mild symptoms competes with care for those most seriously ill.

Let’s start with the idea that mental health has become an umbrella term. The percentage of people who say they have a disorder is a red flag in itself. About 57% of college students claim to have mental health issues. More than three-quarters of parents with school-age children sought help or advice regarding their child’s mental health in 2021-2022.

Research shows that Brits are increasingly likely to describe sadness and stress as mental illness, redefining how we view illness. Most diseases still lack objective biomarkers, so self-reported symptoms carry a heavy weight in official statistics and diagnostic processes.

People have an incentive to classify mild stress as a disorder. In 2022, more than a quarter of 16- and 18-year-olds in schools in the UK were given extra time in official exams because of a health condition. Welfare benefits may be available if there is evidence of a mental health problem. A certificate does not need to come from an NHS doctor and many private clinics are ready to issue one.

Companies may prefer to classify stress as a disorder rather than deal with the consequences of admitting poor working conditions (the World Health Organisation suggests that good management is the best way to protect mental health in the workplace). The poorest people in England have the highest rates of diagnosed depression, but the government would probably prefer to prescribe antidepressants rather than solve poverty.

Medicalizing minor afflictions may not be in patients’ interests — one study of mindfulness courses in 84 UK schools found that regular instruction was just as good for mental health — but the greatest harm from overdiagnosis falls on those who need help most.

In theory, the NHS can triage patients as needed. But in practice, the service, long understaffed and poorly organised, is struggling with soaring demand. The number of young people receiving mental health services has increased by more than three and a half times the child and adolescent psychiatry workforce. The 22% increase in the overall mental health workforce over the five years to 2021-22 will never match the 44% increase in all patient referrals. At least 1.8 million people are waiting for mental health treatment.

Rising demand is driving staff into private practice. Clinicians exhausted from dealing with the NHS’s most serious cases can earn as much as £1,000 ($1,265) for a session diagnosing attention-deficit hyperactivity disorder. There are just 6% more NHS consultant psychiatrists than there were a decade ago, but there are 86% more consultants in emergency medicine.

Police are picking up some of the pieces. Police officers in England spend around one million hours a year with mentally ill patients in emergency departments. But that’s not treatment. Despite increasing awareness of mental illness, outcomes are worsening for people with severe mental illnesses such as bipolar disorder and schizophrenia. They die 15-20 years earlier than the general population, a gap that was widening before COVID-19 and has been exacerbated by it.

A rethinking of Britain’s approach to mental health requires several changes: More funding should be put into research to ensure individuals are treated appropriately. Mental illness accounts for 9% of England’s health budget but 6% of medical research funding. More attention should also be paid to the social causes of mental illness; earlier this year the government shelved ambitious plans to look at the underlying conditions of mental illness, from poverty to isolation, but these should be reinstated. More time and effort should be spent on those who need help the most. Reforming the Mental Health Act, an outdated law that makes people with mental illness feel like criminals, would be a first step.

Cause and effect

Above all, the UK needs to avoid mass medicalisation of minor afflictions. Pumping people into an overburdened health system is having predictable effects. All suffering should be taken seriously, but a diagnosis is not always in a person’s best interests. A recent study found that volunteers were happier when they learned to suppress negative thoughts. The UK has become more compassionate towards mental health. It also needs to become more thoughtful.