After waiting greater than a yr to see an NHS specialist, Sam's diagnosis for ADHD took lower than two hours. It took place over video, included a brief checklist and short history, and ended with a fast decision.
Within weeks, SAM had a diagnosis, a prescription and a discharge letter to the GP. But when the symptoms worsened and the uncomfortable side effects of the medication appeared a number of months later, nobody was sure who was answerable for the follow-up. As we all know from our clinical and research work, such stories are increasingly common in UK mental health and neurodevelopmental services.
Against this backdrop, UK Health Secretary, Wes Streeting, Ordered Expert review of ADHD, autism and mental health diagnoses. Much of the general public discourse has focused on overdiagnosis to suggest that common anxiety is just too quickly labeled a medical illness. Media coverage These concerns have been linked to claims of increased profit for depression, anxiety, autism and ADHD.
The debate will not be nearly clinical validity. There's also who is taken into account too sick to work and what meaning for the state. Some observers suggest that folks pursue evaluations of advantages reminiscent of disability advantages or workplace adjustments. Critics argue that this structure means people as an alternative ask why so many persons are struggling in the primary place.
Although the general public debate is usually focused on individual goals, health services are likely to be pointed to Structural stress. NHS data shows Record demands and pressures on mental health teams. Patients and families Report long waits, repeated reviews and referrals which can be rejected or misdirected, leaving some people completely lost within the system.
Streeting's recent opinion piece Guardian This tension is arrested. He admitted that his earlier statements about overdiagnosis were divisive, and accepted that many individuals may not reach out for help after they need it. At the identical time, he pointed to a pointy rise in referrals for mental health and neurodevelopmental conditions, arguing that a review must uncover what's driving it.
The Center for Mental Health, an independent UK charity that researches mental health policy and practice, welcomes the review but stresses that evidence already points to real increases in poverty, unsafe housing, poverty and distress linked to the pandemic. i A recent statementIts chief executive, Andy Bell, said there had been a transparent upward trend in mental health needs and he had seen no evidence that mental health problems were being over-diagnosed.
Others argue that the argument is fake. Miranda Wolpert, director of mental health at Wellcome, There is a reason The real challenge will not be deciding who's mentally unwell, but match different types of suffering with appropriate support. This support might be clinical therapy or medication, but may also include help with housing, debt advice or peer support.
Professionals have been warning about system design for years. British psychiatrists Concerns have been raised About getting away from an overkill and specialist on generic models. Mental health nurses have spoken out Similar concerns, warning that increasingly widespread training of nurses risks reducing skills and undermining continuity of care.
Seen on this context, what is usually described as overvaluation looks like a predictable final result of the system itself. NHS care is structured across the chain of triage, referral, assessment, diagnosis and treatment. People undergo short assessments and short packages of care before being discharged.
This model rewards speed and fast certainty. It advocates prompt diagnosis, clear diagnostic labels, and protocol-driven treatment—for instance, offering cognitive behavioral therapy or SSRI medication when someone scores above a certain threshold on the questionnaire. This simplifies planning and auditing, but encourages services to treat each case as a transient event that ends abruptly, relatively than as an evolving set of needs that will require ongoing support.
Appraisals develop into the first technique of unlocking. When that is the one mechanism that gives access to medication, therapy or educational support, the speed of diagnosis increases not because persons are exaggerating the issue, but since the system leaves them no other avenue for help.
And once an episode of caregiving ends, responsibility is usually unclear. Patients are discharged with short lines and should be restarted if their needs change. Referrals might be rejected because teams are overwhelmed and must concentrate on those at immediate risk.
Physicians in primary care face similar pressures. Distress related to financial stress, workplace problems or bereavement might be recorded as depression or anxiety, because the diagnosis allows the GPS to prescribe or refer.
Fragmentation in services deepens the issue. Patients are divided between multiple teams, each handling only a portion of their needs. Checklists designed for screening relatively than diagnosis can develop into shortcuts. Depression guidelines, for instance, Be especially careful As against relying solely on symbol counts.
Stress within the workforce further undermines continuity. In our experience, nurses, psychologists, occupational therapists and social employees often provide complex care without constant supervision. Burnout and vacancies undermine the system's ability to supply stable, ongoing support.
The planned review comes at a critical moment as its findings will shape who gets support and the way services are redesigned. Computational assessment is not going to address fundamental issues. The increased rate reflects more system stress than patient behavior.
There is a transparent path forward. Research shows When services are built around separate diagnosis-specific pathways, people can experience delays and fragmented care as they move between teams that only take care of a part of their needs. Recommend studies instead Approaches that concentrate on an individual's suffering and support needs, relatively than forcing them into rigid diagnostic categories.
Better coordination amongst different professions will help teams address overlapping issues, reminiscent of speech and language difficulties in autism or how ADHD medications interact with antidepressants.
Focusing on stricter standards of emergency assistance will make it easier for people to get help earlier and stop crises from occurring. A review that appears closely at how referrals work, how digital tools are used, how the workforce is trained and supported, and the way continuity of care is maintained will provide a more accurate picture of the system's weaknesses and what needs to vary.
The system will not be failing because too many individuals seek help. It is failing because short, discrete episodes of care cannot manage long-term, complex needs. Until that changes, debates about overdiagnosis will proceed to obscure the true issue: making a mental health system that lives with people, relatively than processes them and moves on.