‘Life being stressful is not an illness’

Hundreds of GPs across the UK told the BBC they felt mental health problems were over-diagnosed.

Our research shows that one of the commonly held views of family physicians is that society tends to over-medicalize normal life stresses. But they also worry about how difficult it is for patients with mental health problems to get help.

Earlier this week, the Minister of Health gave instructions an independent review The reasons for the growing demand for mental health, ADHD and autism services in England and where the gaps in support lie.

BBC News sent a survey to more than 5,000 GPs in England asking about their experiences of helping patients with mental health problems. Their answers provide insight into how challenging this issue is for many family physicians.

Of the 752 GPs who participated in our survey, 442 said they believed overdiagnosis was a concern. More said mental health issues are slightly overdiagnosed rather than greatly overdiagnosed.

The 81 GPs who responded felt that mental health problems were underdiagnosed.

Overdiagnosing mental health issues was not their only concern. Many GPs also said they were concerned about the lack of help available to patients.

For our survey, GPs answered a variety of questions and were asked to leave anonymous comments.

One of the most common themes that emerged can be summed up by a quote from a GP: “Life being stressful is not a disease.”

Another commented: “As a society we seem to forget that life can be hard; a broken heart or grief is painful and normal and we need to learn to deal with it.”

Another argued that giving people labels like anxiety or depression “over-medicalizes life and emotional difficulties” and takes resources away from people with serious needs.

A small number of GPs strongly criticized some patients. One described them as “dishonest, narcissistic…gaming a system that is free at the point of use.”

Overall, one in five adults in England report having a common mental health problem such as anxiety or depression, according to research published by NHS England. The rates are even higher in young people. For those aged 16-24, this is one in four.

General practitioners who participated in our research determined that the age group that needs the most support in mental health issues is the 19-34 age group.

One commented that young adults “seem less resilient since Covid”, suggesting they were more interested in making 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,” one person said, while another said services were very reluctant to “fully assess and diagnose” patients.

There are around 40,000 fully qualified GPs in England and we do not know whether the group participating in our research is representative of all GPs.

We asked GPs who have been in practice for at least five years how the time they spend working on mental health has changed. Almost all said it increased.

The three main reasons they gave for this were:

• Having to support patients who cannot get quality mental health help elsewhere
• Practical issues affecting patients’ mental health, such as housing, employment or finances
• Patients who feel they have mental health problems while dealing with normal life challenges

Earlier this year health minister Wes Streeting told the BBC’s Laura Kuenssberg: mental health problems were being overdiagnosed and too many people were being “deleted”. Now he says his comments were “divisive” and “failed to capture the complexity of this issue.”

And this is undoubtedly a problem.

It is thought that 2.5 million people in the UK have ADHD, including those who are undiagnosed. Some NHS services for ADHD close their doors to new patients because they are having trouble coping with the demand.

Patients told the BBC how difficult they find it to receive appropriate care and support.

Ultimately, there is consensus that the NHS is unable to meet increasing demand in this area.

The vast majority of GPs surveyed in our survey, 508 out of 752 GPs, said adequate quality mental health help for adults is rarely or never available in their area.

What’s more, nearly 640 GPs said they were concerned about young patients getting the help they need.

A GP has described mental health support as a “national tragedy”. Another said: “A child literally has to hold a knife to be taken seriously and the moment the knife is dropped services are disabled.”

We also asked GPs if they were prescribing medication because they were worried patients might not get other help quickly enough, such as speech therapy.

The most common response from 447 GPs was that they do this “routinely”.

“I find myself regularly reaching for antidepressants, knowing that these can only help in the short term and will not help prevent relapse,” commented one GP.

Professor Victoria Tzortziou Brown, president of the Royal College of General Practitioners, said there was a “difficult balance” for family doctors to strike when patients expected a diagnosis of mental health problems but did not meet the criteria.

“As a society, we must be careful not to medicalise all normal emotions and behaviors and ensure that GPs are not forced to make diagnoses that conflict with their clinical judgement,” he said.

“But equally we must avoid treating genuine mental health concerns as ‘over-diagnosis’, which risks deterring people from seeking help.”

An independent review of demand for mental health services has promised to hear all the evidence and provide “genuinely useful” recommendations.

Additional reporting by Phil Leake.