‘Stressful life is not an illness’: GPs on mental health overdiagnosis

Hundreds of GPs across England have told the BBC they believe mental health problems are being overdiagnosed.

Our research suggests that a common view among family physicians is that society tends to over-medicalize the stresses of normal life. But they are also concerned about how difficult it is for patients with mental health problems to get help.

Earlier this week, the Health Secretary ordered an independent review into the reasons for the growing demand for mental health, ADHD and autism services in England, and where the gaps in support are.

BBC News sent a questionnaire to more than 5,000 GPs in England asking them about their experiences helping patients with mental health problems. Their responses give an idea of ​​how challenging this topic is for many family physicians.

Of the 752 GPs who took part in our research, 442 said they believed overdiagnosis is a concern. More said mental health problems were overdiagnosed by a little than overdiagnosed by a lot.

Eighty-one GP respondents felt that mental health problems were underdiagnosed.

Overdiagnosis of mental health problems was far from their only concern. Many GPs also told us they were concerned about the lack of help for patients.

For our questionnaire, GPs answered several questions and were invited to leave anonymous comments.

One of the most common themes that arise can be summed up in this comment from a family doctor: “Stressful life is not a disease.”

Another commented: “As a society we seem to have forgotten that life can be hard – a broken heart or grief is painful and normal, and we have to learn to cope.”

Another argued that labeling people as anxious or depressed “over-medicalizes life and emotional difficulties,” and that this was taking resources away from people with serious needs.

A small number of GPs were very critical of some patients. One described them as “dishonest, narcissistic… gaming a free system at the point of use.”

Overall, one in five adults in England report having a common mental health condition, such as anxiety or depression, according to a survey published by NHS England. The rates are even higher among young people. Among young people between 16 and 24 years old, it is one in four.

GPs who took part in our research identified people aged 19-34 as the age group who needed the most support with mental health problems.

One commented that young adults “seem to be less resilient since Covid”, suggesting they are more concerned about getting a diagnosis than finding coping strategies.

But other GPs said the real problem was underdiagnosis.

“People need to be accepted, helped and encouraged to live life,” said one, while another said services were very reluctant to “fully assess and diagnose” patients.

There are almost 40,000 fully qualified GPs in England and we cannot know whether the group taking part in our research is representative of all GPs.

We asked GPs who had been in work for at least five years how the amount of time they spent working in mental health had changed. Almost everyone said it has increased.

The three main reasons they gave for this were:

• having to support patients who cannot get good quality mental health help elsewhere
• Practical issues such as housing, employment or finances that affect patients’ mental health.
• patients who think they have a mental health problem, when faced with normal challenges in life

Earlier this year, Health Secretary Wes Streeting told the BBC’s Laura Kuenssberg that mental illnesses were being overdiagnosed and too many people were being “ruled out.” He now says his comments were “divisive” and that he “failed to grasp the complexity of this issue.”

2.5 million people in England are thought to have ADHD, including those without a diagnosis. Some NHS ADHD services have closed their doors to new patients because they are struggling to cope with demand.

Patients have told the BBC how difficult it is for them to get the right care and support.

Ultimately, there is consensus that the NHS is not meeting the growing demand in this area.

A clear majority of GPs who took part in our research, 508 out of 752, said there was rarely or never enough good quality mental health help available to adults in their area.

What’s more, some 640 GPs told us they were concerned about giving young patients the help they needed.

A GP called mental health support “a national tragedy”. Another said: “A child literally needs to hold a knife to be taken seriously and the moment they drop it, services are disconnected.”

We also asked GPs if they ever prescribe medication because they are worried that patients will not receive other help, such as talking therapies, quickly enough.

The most common answer, from 447 GPs, is that they do it “routinely”.

“I find myself regularly turning to antidepressants, which I know can only help in the short term and will not help prevent recurrence,” said one GP.

Professor Victoria Tzortziou Brown, president of the Royal College of GPs, said there is a “difficult balance” for GPs when patients expect a diagnosis of mental health problems but do not meet the criteria.

“We must be careful, as a society, not to medicalise the full range of normal feelings and behaviors and ensure that GPs are not pressured to make diagnoses that conflict with their clinical judgement,” he said.

“But we must equally avoid dismissing genuine mental health concerns as ‘overdiagnosis’ which risks deterring people from seeking help.”

The independent review of demand for mental health services has promised to listen to all the evidence and produce “really useful” recommendations.

Minesh Patel, associate director of policy and influence at mental health charity Mind, said there was “no credible evidence” that mental health problems were being overdiagnosed.

“However, what we do know is that the number of people experiencing mental health problems has increased: 1 in 5 adults now lives with a common mental health condition, according to the Adult Psychiatric Morbidity Survey,” he said.

Additional reporting by Elena Bailey and Phil Leake.