‘Life being stressful is not an illness’

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

Our research shows that one of the most common views of family physicians is that society tends to overmedicalize the ordinary stresses of life. But they are also concerned about how difficult it is for mental health patients to get help.

Earlier this week, the Minister of Health ordered independent review on the reasons for the growing demand for mental health, ADHD and autism services in England, and the gaps in support.

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

Of the 752 GPs who took part in our study, 442 said they believed overdiagnosis was a problem. More said mental health problems were overdiagnosed by a few, not many.

Eighty-one GPs who responded to the survey felt that mental health problems were underdiagnosed.

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

In our questionnaire, GPs answered several questions and were invited to provide anonymous comments.

One of the most common themes can be summed up in a comment from a general practitioner: “A life full of stress is not a disease.”

Another commented: “As a society we seem to have forgotten that life can be hard: heartbreak or heartbreak is painful and normal and we must learn to cope with it.”

Another argued that labeling people such as anxiety or depression “overmedicates life and emotional difficulties” and that it takes resources away from people with serious needs.

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

Overall, one in five adults in England report having a common mental disorder such as anxiety or depression, according to a survey published by NHS England. Among young people the rates are even higher. For 16-24 year olds it is one in four.

GPs in our study identified the 19 to 34 age group as most in need of support for mental health problems.

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

But other GPs said the real problem was under-diagnosis.

“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 in our study is representative of all GPs.

While the government survey will focus on mental health, autism and ADHD services, our survey focuses specifically on mental health. Some GPs also commented on neurodiversity, but we only used comments related to mental health.

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

They gave three main reasons for this:

• the need to support patients who cannot obtain quality mental health care elsewhere
• practical issues such as housing, employment or finances affecting patients' mental health.
• patients think they have mental health problems even though they are facing normal life problems

Earlier this year, Health Secretary Wes Streeting told the BBC's Laura Kuenssberg that mental disorders were overdiagnosed and too many people were “written off.” He now says his comments “caused controversy” and that he “failed to grasp the complexity of the issue.”

It is believed that 2.5 million people in England have ADHD, including those who do not have a diagnosis. Some NHS ADHD services have closed. new patients because they are struggling to cope with demand.

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

There is general consensus that the NHS is not meeting growing demand in this area.

The vast majority of GPs in our study, 508 out of 752, said that adults in their area rarely or never had enough quality mental health care.

What's more, around 640 GPs told us they were worried about making sure young patients got the care they needed.

One doctor called mental health support a “national tragedy.” Another said: “The child literally needs to hold a knife to be taken seriously and once the knife is down the services are cut off.”

We also asked GPs if they ever prescribe medication because they are worried that patients will not be able to get other help, such as talk therapy, quickly enough.

The most common answer – from 447 GPs – is that they do it “regularly”.

“I take antidepressants regularly, which I know can only help in the short term and will not help prevent relapse,” commented one GP.

Professor Victoria Tsorziou Brown, chair of the Royal College of GPs, said GPs face a “difficult balance” when patients are awaiting a diagnosis of mental health problems but do not meet the criteria.

“We as a society must be careful not to medicalize the full range of normal feelings and behavior, and ensure that GPs are not forced to make diagnoses that conflict with their clinical judgment,” she said.

“But equally, we must avoid dismissing real mental health problems as ‘over-diagnosis’, which can discourage people from seeking help.”

An independent review of demand for mental health services has promised to listen to all the evidence and make “really helpful” recommendations.

Minesh Patel, deputy director of policy and impact at mental health charity Mind, said there was “no credible evidence” that mental health problems were over-diagnosed.

“What we do know, however, is that the number of people experiencing mental health problems has increased, with one in five adults now living with a common mental illness, according to the Adult Psychiatric Morbidity Study,” he said.

Additional reporting by Elena Bailey and Phil Leake.