Are We Over-Medicalising Mental Health?

Health Secretary Wes Streeting has suggested there is an “overdiagnosis” of mental health conditions. Speaking on the BBC’s Sunday with Laura Kuenssberg programme, he said, “mental wellbeing, illness, it’s a spectrum and I think definitely there’s an overdiagnosis, but there’s too many people being written off”.

Streeting was speaking about planned government reforms aimed at reducing the benefits bill, but his comments chimed with evidence suggesting that mental health in the United Kingdom has worsened in recent years and concerns about the effectiveness and availability of treatment.

As part of its ‘Change the Prescription’ research, the Centre for Social Justice (CSJ) polled 1001 GPs. The think tank found four in five GPs were worried that the stresses and strains of everyday life are being too readily treated as medical problems. Additionally, 83% also felt antidepressants are being prescribed when non-pharmaceutical interventions may be more suitable.

The CSJ’s report called for a shift towards non-pharmaceutical treatments such as therapy services and community-based support. It argued that this would ensure medicalised care is reserved for those with genuine needs.

Concerns Over Neglecting Vulnerable Patients 

However, mental health charity Sane has warned that reducing medical interventions could leave vulnerable patients without adequate care from GPs.

“Levels of psychological suffering like physical conditions can vary between individuals,” said Marjorie Wallace, chief executive of mental health charity Sane. “While some people are able to ride it out, for others it can cause acute distress. Worryingly, the evidence is that particularly among young people, there has been an increase in the numbers reporting feelings of anxiety, depression, and conditions that make life extremely hard for them,” she told Medscape News UK. 

These conditions must be taken seriously and not dismissed for being self-reported or exaggerated, she added.

“Some, indeed, may be due to the proliferation of ‘new labels’, which can become fashionable through social media. But amongst these, there will be someone who is struggling and in need of urgent, early professional help. Problems are often invisible and fluctuate from month to month or day to day. The worst thing to happen when someone seeks help is that they are not taken seriously,” Wallace stressed.

Sane has reported an “alarming” increase in calls to its helpline from people who have self-harmed or who are experiencing suicidal thoughts. The rise has particularly been seen in young women, she confirmed.

GPs Call for More Support Options

It’s a thorny area of healthcare for GPs to navigate. Dr Abbie Brooks, a GP partner at Priory Medical Group in York, acknowledged the challenge of balancing pharmaceutical options such as selective serotonin reuptake inhibitors (SSRIs), and non-pharmaceutical treatments, including cognitive behavioural therapy (CBT) or support in the community. “As a GP, I want to be able to offer my patients a number of options to help support them,” Brooks explained to Medscape News UK. “Medication such as SSRIs can be life-changing for some, but they are not the solution for every patient with depression, anxiety, or other mental health symptoms.

“Every week I see and speak to people who are struggling with their job, or family, or financial issues, or bereavements – and finding the right support for these patients is key. But cognitive behavioural therapy is not for everyone, as many patients struggle with group work or online CBT, and they need more personalised support.”

The CSJ report urged GPs to consider helping patients to access therapy services and community support, such as social prescribing, as an effective alternative to reducing antidepressant use. Lack of quick access to these services is an issue, however.

Community-Based Solutions

Brooks explained that her practice has a waiting list for talking therapies, such as counselling and guided self-help. There’s also a waiting list for the social prescribing team. “If we had funding available for one to two more social prescribing link workers, it would really benefit our patient population.”

Brooks’ practice primarily offers CBT. “But many patients don’t need CBT or medication for their mental health symptoms. Instead, they need support with specific tasks and someone to root for them,” she said. 

As a parkrun practice, Priory Medical Group encourages patients to participate in the free weekly 5K run or walk. or volunteer instead) helps patients with both their mental and physical health. she explained. “I think the community aspect of parkrun can really benefit people who are feeling lonely or isolated. Knowing that the people of parkrun are there come rain or shine can be particularly helpful,” she said. 

Barriers to Accessing Mental Health Care

Wallace agreed that CBT can be helpful but noted that it is often treated as a quick fix. “After six to 10 CBT sessions, a significant number of people in our experience are sent back to their GP – and the beginning of the queue again.” 

Brooks highlighted the frustration of securing referrals for specialist mental health care. “The NHS should offer clear and supportive referral pathways for patients that would benefit from the expertise of a psychiatrist or mental health specialist team,” she urged. “It is a minefield for patients navigating referral pathways, especially for ADHD, and it can often feel like they are just facing barriers and obstacles. 

“I find it so frustrating that I cannot just pick up the phone or send an email to my local psychiatry team and have a discussion about a treatment plan. It must be even more frustrating for the patient in the middle of it all, ” she added.

Sane supports a balanced approach, combining medication, therapy, and community-based support. The National Institute for Health and Care Excellence also recommends this model. 

Wallace welcomed the expansion of talking therapies but warned that the “fundamentals of good mental healthcare” are often still lacking. These include insufficient psychiatric beds available locally for patients in crisis and for those who need longer-term care. Shortages of skilled and trained staff in the community and in inpatient settings, are also a problem, she said.

The CSJ research found almost a fifth of adults in England are taking antidepressants. While this could be partly due to overprescribing access to alternatives like therapy and social prescribing remains limited and not straightforward as it ought to be.

Wallace and Brooks disclosed no relevant financial interests. 

Julie Penfold is a freelance journalist specialising in healthcare and medical content. Her work regularly appears in titles such as Medscape, Doctors.net.uk, and Hospital Healthcare Europe.