I have spent a significant part of the past year working in an overstretched emergency department. I have been shocked at how many A&E patients I have seen present with mental health conditions. Often young and vulnerable, they attend with a variety of complex needs, none of which are easy for emergency teams to fix up, let alone properly fix.
Less surprising, but no more alarming, is that these patients have their issues exacerbated by the hospital setting, one that inherently is not suited to them, the very nature of emergency departments, being loud, noisy and often full of chaos.
I sympathise with these patients, who often are dealing with great turmoil in their lives and within themselves, but who then have to wait for hours before being told that there is little to be done until they can be reviewed by the liaison psychiatry team.
At a time when such patients often wait more than 18 months to access appropriate treatment, the health secretary Wes Streeting ought not to be warning about the “overdiagnosis” of mental health conditions.
If we were seeing an increase in patients with heart attacks, asthma exacerbations or arthritis, would we be referring to it as an “overdiagnosis”? I rather think we would be referring to it, rightly, as a crisis.
The implication from his comments is that the medical profession should be more circumspect with the growing number of patients who self-diagnose with mental disorders – and, despite decades of pushing for cultural change with how we deal with such patients, be less quick to reach for the prescription pad or to sign them off as unfit to work.
Streeting’s intervention comes ahead of the government’s announcement of cuts to the budget for welfare benefits, which is expected later this week. According to official figures, more than half of the rise in working-age disability claims since the pandemic is connected to mental health or behavioural conditions. According to the health secretary: “I think there’s an overdiagnosis – but also there are too many people being written off […] We’ve got to reform the system to make sure it’s still there as both a safety net but also a springboard back to work.”
If patients are being overdiagnosed with mental-health conditions, that’s the fault of doctors like me, is it? Not always.
It’s certainly not within a doctor’s best interest to overdiagnose; inevitably, it would lead to re-admissions and repeated appointments. Likewise, the rise in mental health conditions are related to wider social measures such as poverty, and represent a problem with inequality as a whole, which NHS staff cannot fix. Root causes aren’t for doctors to solve – that’s for politicians.
Despite this, I would contend that there has been a rise of inappropriate diagnosis with some mental health conditions, such as ADHD. A few years ago, a BBC Panorama documentary exposed how easy it is to get a private clinic diagnosis of ADHD – often not from an appropriate clinician.
Among my peers, there is a general feeling that increased exposure to and awareness of mental health conditions over the past decade – something that was desperately needed and fought for – has led to more patients than ever believing they have mental health problems. It is hard to say if they really do.
Given the non-specific symptoms that many mental health conditions carry – from tiredness and low mood to agitation – patients who are understandably worried begin to search online and self-diagnose. Anecdotally, the proliferation of TikTik clips that connect non-specific symptoms with a particular diagnosis has lead to patients seeking help from their GP or attending A&E with a diagnosis in mind – which is ironic, given that the platform has long been held up as being responsible for exacerbating anxiety, sleep deprivation and depression as well other contributing to low confidence and self-esteem.
Particularly in the case of ADHD and other disruptive behavioural disorders, the symptoms can be truly debilitating – and yet young people who sometimes feel “a bit restless” are being easily led by social media to self-diagnose, trivialising those with these conditions in the process.
I appreciate that it is not normal for a country to have more than half of the working age disability claimants since the pandemic being related to mental health or behavioural conditions. Something needs to be done.
The Labour government’s commitment to increasing the number of mental health staff is to be applauded. But the health secretary’s suggestion that doctors are adding to the pressures on the NHS by overdiagnosing mental health conditions needs a second opinion.
Dr Ammad Butt is a doctor in Birmingham
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