Yesterday (Dec 4), Health Secretary Wes Streeting announced that he would be launching an independent review into rising demand for mental health, ADHD, and autism services in England.
On the surface, this might seem like a good thing – mental health and neurodivergence healthcare is stretched thin in the UK, people are crying out for help, so what we need to do is find a way to improve those services so that people can get the support they need, right?
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Unfortunately, no.
In fact, the headline aim of this review is to see whether there is evidence of over-diagnosis, with the BBC reporting that the government “believes there are people being referred onto waiting lists who do not need treatment.”
Streeting himself said these conditions were being over-diagnosed earlier this year, though he has since claimed in a piece for The Guardian that those remarks were “divisive” and had “failed to capture the complexity of this problem”.
He wrote: “The truth is there has been a massive growth in mental health and behavioural issues and there isn’t a consensus within the mental health clinical community on what is driving it. We must look at this through a strictly clinical lens to get an evidence-based understanding… That’s the only way we can ensure everyone gets timely access to accurate diagnosis and effective support.”
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But, despite Streeting’s attempts to roll back his earlier comments about over-diagnosis, an emphasis on questioning what is “driving” an increase in mental health and neurodivergent diagnoses rather than how to support that increase is both erroneous and borderline offensive.
There is already widespread and growing stigma about conditions like ADHD, with regular discourse online and among politicians about whether those diagnosed are “truly” struggling, and language about finding “evidence” for what is behind this surge in demand only adds to that rhetoric.
I was diagnosed with ADHD nearly two years ago, after waiting 1.5 years for a diagnosis. To many, that might not sound like too long – in some places, there can be up to a 10-year wait for diagnosis – but I was battling with my symptoms long before I was first referred to a Right to Choose provider for assessment. I spent years struggling with basic household tasks, relationships, and school and work, finding myself unable to focus for long periods, and berating myself for not being “normal” like everyone else around me.
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This was particularly bad during university when I had a lack of structure and was forced to discipline myself – something that people with ADHD notoriously find difficult – leading to me being diagnosed with severe anxiety and depression. It turns out that the deterioration in my mental health was a result of not knowing about my ADHD and therefore not dealing with it in the right way.
I also battled with internalised stigma about having ADHD, overrun by narratives that people are lying about having the condition, conning themselves into believing they have ADHD, or that it’s not so serious that it even requires diagnosis and intervention.
Many people with ADHD grapple with similar difficulties, meaning they are reluctant to seek a diagnosis or are not believed when they do. Receiving a formal diagnosis was important to me both to feel validated in how I approached work, relationships, and life itself in the past as well as to ensure that I was legally entitled to receive specialist support for the condition. Without a diagnosis, that can be much harder.
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At one previous job, for example, I was unable to obtain reasonable adjustments – and received zero empathy from my line manager – until I received a formal diagnosis, meaning I was protected under the 2010 Equality Act.
The current system we operate under does leave many people being “written off”, like Streeting said, but not in the way he might think. It is not due to over-diagnosis but rather chronic underfunding and complex healthcare systems that are not fit-for-purpose, that leaves people in the dust.
Streeting’s review is also looking to “raise the healthiest generation, increase healthy life expectancy, and reduce suicide”, but further stigmatisation of these conditions is in direct conflict with that goal.
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People with ADHD are in fact more at risk of suicide and have a lower life expectancy than those who are neurotypical, with 1 in 4 women, and 1 in 10 men, with ADHD will at some time try to take their own lives, while people with ADHD are likely to die between seven and nine years younger than their peers. This is why it is so important for people to be able to access mental health and neurodivergent diagnoses and support.
For Streeting to suggest that the rise in demand requires any intervention apart from additional funding as well as empathy for those struggling, is ridiculous.
I am not the only one who thinks so. Henry Shelford, CEO of campaigning organisation ADHD UK, told HuffPost UK: “ADHD is not overdiagnosed. A recent Lancet study published research that analysed 9 million GP records and showed just 0.32% of patients have a diagnosis of ADHD. That’s nudging just 10% of the 3-4% of the population who have ADHD.
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“We’re underdiagnosed, not overdiagnosed. In addition, a BBC study showed the average wait for an ADHD diagnosis in England is 8 years. The idea that you can achieve overdiagnosis with an average wait of nearly a decade is just preposterous.”
If Streeting wants fewer people to be struggling with ADHD, autism, and associated mental health conditions, then the answer is to invest in those services and support the people who need it rather than blaming them for getting diagnosed in the first place. Focusing on “overdiagnosis”, and refusing to acknowledge just how broken our system is, will push more and more people to breaking point – and the whole country will be worse-for-wear as a result.
