How to stop over-medicalising mental health - "FOR A PLACE with a reputation for buttoned-up stoicism, Britain is remarkably open about mental health. The British are more likely than people in any other rich country to think that mental illness is a disease like any other. Only the Swedes are more accepting of the idea that a history of mental-health problems should not disqualify someone from public office. The importance of good mental health is a cause vigorously championed by everyone from the Princess of Wales to the opposition leader, Sir Keir Starmer; employers preach the gospel of well-being. Britons were once encouraged to hide their feelings; now they are urged to seek support. Much of the rich world has struggled with rising rates of self-reported mental-health problems, particularly since the covid-19 pandemic. But the numbers in Britain are startling. Around 4.5m Britons were in contact with mental-health services in 2021-22, a rise of almost 1m in five years. In the past decade no other European country has seen a greater increase in the use of antidepressants. A National Health Service (NHS) survey in 2023 found that one in five 8- to 16-year-olds in England had a probable mental disorder, up from one in eight in 2017. In 17- to 19-year-olds the figure had increased from one in ten to one in four. The number of people who are out of work with mental-health conditions has risen by a third between 2019 and 2023. It is good that people do not feel they must bottle things up and the suffering from mental illnesses is real. Awareness of mental health has diminished the stigma of some conditions and revealed that many Britons’ needs are not met. But awareness has caused damage, too. For all their good intentions, campaigns intended to raise awareness are leading some people to conflate normal responses to life’s difficulties with mental-health disorders. Special treatment creates incentives for people to seek diagnoses and to medicalise problems unnecessarily. The need to treat people with milder conditions competes with care for those who have the most severe ones. Start with the idea that mental health has become a catch-all term. The sheer proportions of people who say they have a disorder is a red flag. Some 57% of university students claim to suffer from a mental-health issue; over three-quarters of parents with school-age children sought help or advice over their child’s mental health in 2021-22. In surveys Britons increasingly describe grief and stress as mental illnesses, redefining how sickness is understood. Most conditions do not yet have objective biomarkers, so self-reported symptoms weigh heavily in official statistics and in diagnostic processes. People have incentives to label mild forms of distress as a disorder. In 2022 more than a quarter of 16- and 18-year-olds in British schools were given extra time in official exams because of a health condition. Evidence of a mental-health problem can unlock welfare payments. Certification need not come from an NHS doctor: plenty of private clinics stand ready to provide it. Firms may prefer to label stress a disorder rather than deal with the consequences of acknowledging that working conditions are poor (the World Health Organisation implies that good management is the best way to protect mental health in the workplace). The highest rates of diagnosed depression occur among England’s poorest people, but the government probably prefers prescribing antidepressants to trying to solve poverty. Medicalising mild distress may not benefit patients. One study of mindfulness courses in 84 British schools found that normal teaching was just as good for mental health. But the great harm from overdiagnosis is to those who most need help. The NHS, in theory, is able to triage patients by need. In practice, a service that has long been understaffed and poorly organised is struggling with surging demand. The number of young people in contact with mental-health services has expanded at more than three and a half times the rate of the workforce in child and adolescent psychiatry. A 22% increase in the overall mental-health workforce in the five years to 2021-22 could never have matched a 44% increase in referrals for all patients. At least 1.8m people are waiting for mental-health treatment. Increased demand is driving staff into private practice. Clinicians burned out from dealing with the most severe NHS cases can earn as much as £1,000 ($1,265) a session conducting assessments of attention-deficit hyperactivity disorder. The NHS has only 6% more consultant psychiatrists than a decade ago, compared with 86% more consultants in emergency medicine. The police pick up some of the pieces—officers in England spend around 1m hours a year with mental-health patients in accident-and-emergency departments—but that is not treatment. Even as awareness of mental-health conditions rises, outcomes for people with severe mental illnesses, such as bipolar disorder and schizophrenia, are worsening; they die 15-20 years earlier than the rest of the population, a gap that was widening before covid-19 and was exacerbated by it. Rethinking Britain’s approach to mental health requires several changes. More money should go on research so that individuals are treated appropriately; mental disorders absorb 9% of England’s health budget but 6% of medical-research funding. The social causes of mental illness should also receive more attention. Earlier this year the government shelved an ambitious plan to look at the underlying context for mental disorders, from poverty to isolation; that plan should be revived. More time and effort should be devoted to those most in need of help; reforming the Mental Health Act, an outdated law that leaves the mentally ill feeling like criminals, would be a start. Above all, Britain needs to avoid the mass medicalisation of mild forms of distress. Funnelling people into an overstretched health-care system is having predictable effects. All suffering should be taken seriously, but a diagnosis is not always in someone’s best interests; one recent piece of research found that volunteers were happier when they learned to suppress negative thoughts. Britain has become more compassionate about mental health. It needs to become more thoughtful, too."
Detecting schizophrenia myths - "assaults are committed by 1 in 7 untreated schizophrenics and by 1 in 10 treated schizophrenic patients per year. Treatment is only moderately effective in this regard. These are very high rates compared to the general public. Even with a relatively weak predictor, you need to monitor only 2 or 3 patients to possibly prevent an assault. This would be a highly effective intervention, and should receive more publicity. Large et al. seem to be doubtful about the value of screening in general, but their own data show it has utility for assaults. For violent crime, monitoring 26 patients is required for a possible prevention of a violent crime. Again, this is manageable given resources. Homicide in untreated patients happens, according to this table, at the very high rate of 1 in 600 schizophrenics. That compares with homicide rates in the UK of 0.9 per 100,000 persons and in the US of 3.9 per 100,000 persons. (US 4 times as murderous as the UK). So, the rate of homicide in non-schizophrenics in the UK is 1 in 111,111 and in the US is 1 in 25,641 persons. Therefore, an untreated schizophrenic person, using the estimates given in this paper, is apparently about 42 times more likely to murder someone than a US citizen, and 185 times more likely to murder someone than a UK citizen. Can these figures be correct? If so, this is a very dangerous category of person. An instrument with a positive predictive value of 0.66% (extremely low) requires that 151 persons be monitored. This would be onerous, but would prevent a murder. It is an indicator of the level of risk to the population when patients do not take their medication. A homicide committed by a treated patient (1 in 10,000) means that treated schizophrenics are apparently 11 times more dangerous than UK citizens and almost 4 times more dangerous than US citizens. In the US it requires 2500 patients being monitored, a high number, and the best estimate of how difficult it would be to prevent one person being murdered, assuming most patients comply with treatment. Monitoring for most patients would probably involve no more than chasing up non-attenders at follow-ups, and doing some random checks on compliance with medication. This would be worth studying, particularly now that monitoring in diabetes is being trialled using mobile phone apps, with good results. Here are a few reflections. Risk estimates vary considerably, but all are raised for schizophrenics, particularly in the early untreated phase. By implication, a schizophrenic patient who does not comply with medication falls into a high risk category. It seems very worth-while to screen for assaults, violent crime and homicide, particularly in untreated or medication-refusing schizophrenics. Being alarmed about schizophrenia is understandable, and wishing them to have treatment and comply with treatment is also comprehensible... In this 3 million person population sample, schizophrenics are 7.7 times more violent, bipolars 3.7 times more violent. Some mental disorders lead to violence. It would be good to get more details on the types of violent criminal event, but from the public’s point of view, the picture is clear enough."
So much for the mentally ill being more likely to be victims of violence than to be violent, therefore we shouldn't try to stop them from being violent
People with severe mental illness as the perpetrators and victims of violence: time for a new public health approach - The Lancet Public Health - "People with mental illness are much more often the victims of violence rather than the perpetrators. However, people with some types of mental disorder are more likely to be violent than others in the general population, a fact that is uncomfortable for many in the mental health sector. While there is little evidence to suggest that people with mental illness in general (usually those with diagnoses of depression or anxiety disorders) have any increased risk of perpetrating violence compared with the general population, higher rates of violence perpetration have been identified among people with particular types of severe mental illness, namely schizophrenia and bipolar disorder. These rates are moderately raised compared with the general population, with an important caveat: people with triple morbidity (ie, individuals with severe mental illness and substance use disorder and antisocial personality disorder) are substantially more likely to be violent than people with severe mental illness alone... The authors calculated that 5·3% of all violent incidents in England & Wales in 2015–16 were committed by people with severe mental illness"
If potential attackers are known to the state, why don’t we stop them? - "Across England, recent data show dozens of killings every year involving patients in recent contact with NHS mental health services – a small minority of patients, but a stubborn, high‑risk cohort. The individual stories differ, but the pattern is the same: serious mental illness, escalating red flags, contact with services, bureaucratic drift, and then disaster... We should not kid ourselves that counter‑terrorism fills the gap. MI5 and counter‑terrorism policing are not, and cannot be, a national safety net for every disturbed, angry man who might pick a target and pick up a knife. Nor should we passively accept a new orthodoxy that slaps an ideological label on every atrocity. The truth is that some people will be motivated by a coherent extremist worldview; others by a scrambled mess of personal grievance, paranoia and online hate detritus. Too many of our protective structures are still built around ideology first and risk second. What is missing is exactly what these cases expose: a single, executive, high‑risk management capability that starts from the question, “Who can do the most harm?” rather than “Which silo do they fit in?”"
Clear proof that stigma about mental health is leading to all the murders, and we need to treat the mentally ill with more compassion
Meme - The Paradox of Awareness: How Mental Health Campaigns Can Cause Harm
Step 1: Lower the Threshold
NORMAL DISTRESS & TRAUMA
DIAGNOSTIC THRESHOLD
MENTAL HEALTH PROBLEM
Concept creep expands definitions of "harm" and "trauma," lowering the bar for what qualifies as a mental health problem.
Step 2: Pathologise Normal Distress
NORMAL STRESS/SADNESS
SYMPTON OF CLINICAL DISORDER
Increased vigilance for "signs of illness" causes people to reinterpret normal stress or sadness as symptoms of a clinical disorder.
Step 3: Trigger the Nocebo Effect
TRIGGER WARNING
ANTICIPATED & EXPERIENCED DISTRESS
Negative expectations and "trigger warnings" can actually worsen symptoms by causing individuals to anticipate and experience more distress.
Step 4: Adopt an Illness Identity
CULTURAL BELIEFS
SYMPTOM-SEEKING BEHAVIOR
ILLNESS IDENTITY
MALADAPTIVE COPING
Once individuals self-label with a disorder, they activate cultural beliefs that reinforce symptom-seeking behaviors and maladaptive coping.
Overall Outcome: Expanded definitions create a self-reinforcing cycle of perceived illness and increased mental health problems among youth."
Michael Inzlicht on X - "Imagine a 19-year-old scrolling TikTok. She watches a creator list five "signs you have undiagnosed anxiety." She recognizes three in herself. By the end of the week, she's describing herself as anxious to her friends. A month later, she's avoiding situations she used to handle fine. What went wrong? In a new paper by my PhD student Dasha Sandra, titled "Why mental health awareness can harm: Converging explanations for a societal problem", we argue that well-meaning mental health awareness can backfire, and we identify how. Four separate literatures (concept creep, nocebo effects, prevalence inflation, and illness self-labeling) have been circling the same problem from different angles. We show they converge on three mechanisms:
1.Awareness lowers the threshold for what counts as a disorder.
2. It trains people to scan their inner lives for symptoms and reinterpret normal distress as pathology.
3. Once someone adopts an illness identity, they behave in ways that confirm and deepen it.
The evidence is wide. Learning that loneliness is harmful makes solitude feel worse. Learning that stress is harmful worsens well-being and performance. Awareness videos about fake conditions like "wind turbine syndrome" produce real headaches. Trigger warnings raise anticipatory anxiety without reducing distress. This does not mean awareness should stop. It means awareness can have unintended consequences, including manufacturing the suffering it tries to prevent. Inoculating people against these mechanisms works, and we already have evidence it does."
Time for more "awareness" to reduce "stigma"
Carolyn D. Gorman on X - "Virginia is quietly setting up to mandate all 6-12th graders be screened for mental conditions annually—will push HUGE numbers of kids toward to mis- and overdiagnosis. @ALegalProcess —who spots more scary details in legalese than anyone else—writes how bad it is. @CityJournal"
Carolyn D. Gorman on X - "States that do not mandate universal school mental health screening are not in the clear. At least one-third of districts nationwide are already doing this. States must PROHIBIT universal school mental health screening."
J.D. Haltigan, PhD 🏒👨💻 on X - "School-based mental health interventions & SEL that prioritize & hyperfocus on emotions & feelings have been a disaster for young people. They are reverse-CBT. They pathologize normal developmental experiences."
The fine line between the cure and the illness: the risks of prescriptive emotionality and sociality for youth mental health - "School-based initiatives are increasingly promoted as solutions to the youth mental health crisis, with Social Emotional Learning (SEL) among the most widely adopted frameworks worldwide. While designed to foster healthy socio-emotional development, evidence for SEL’s long-term mental health benefits remains mixed. Concerns are also growing that universal, non-targeted SEL programs may inadvertently pathologize normal developmental experiences, reinforce self-monitoring, or generate cultural mismatches that undermine resilience. In this personal view, we examine key challenges associated with universal (i.e., non-targeted and intended for all students regardless of baseline risk) school-based programs modeled on SEL. While acknowledging their potential to promote youth well-being, we argue that prescriptive approaches to emotions and sociality can foster confusion among families, resistance among youth, and unintended distress. We highlight risks stemming from conceptual ambiguities and variability in implementation. Rather than abandoning universal programs, we call for rigorous evaluation, cultural adaptation, and integration within broader ecosocial-strategies to foster authentic, context-sensitive resilience in youth."
Clearly, we need even more awareness about mental health
Blackpool is a microcosm of all that’s wrong with Britain - "One local psychologist reported seeing adolescents pre-diagnosing themselves with anxiety and ADHD based on TikTok videos. They consider these pathologies a “badge of honour”, competing with their pals over who is having the bigger “menty b”... The expansion of the therapeutic state is at the expense of the family, teaching the young that external validation, not internal resilience, is the secret to personal thriving. Citizens risk being recast into patients, public servants into mood managers, workplaces from economic engines into self-care mills."
Britain has fallen for the great anxiety scam hook, line and sinker - "Suddenly, for no discernible reason, everyone was talking about “anxiety”. Not as a fact of life. Not as a mundane, fleeting sensation experienced by approximately 100 per cent of the US population at one time or another – 100 per cent of the global population, in fact – but in a dark, loaded way. This was “Anxiety” with a capital “A”. A grave new modern condition that elevated sufferers above the masses, gave them victim status, absolved them of responsibility and necessitated urgent psycho-medical attention. Crucially, it was intransigent – there to stay. People didn’t “feel anxious”, because that implied it would pass; they “suffered from Anxiety”... we haven’t just bought into the silliness – we’ve fallen for the great anxiety scam hook, line and sinker. I use the word “scam” advisedly. Because as revealed in a report over the weekend, British taxpayers are shelling out £800 every minute in disability benefits to people claiming to suffer from anxiety. Indeed, the Personal Independence Payment (PIP) cost for treating this disability/normal human emotion has soared from less than £100m in 2019 to nearly £427m last year. With the rules currently allowing anyone (irrespective of income) to collect those payments without ever seeing a doctor, that figure will presumably mushroom... do I believe that one in 10 Britons suffers from an anxiety disorder? Nope. Sorry. As for data showing that “20 per cent of UK adults feel anxious most or all of the time”, well, that depends on how you define anxiety, doesn’t it? If you define it as living life – as sitting in traffic jams, having occasional disagreements with friends or family, and your Deliveroo driver having “another stop along the way” – then, sure, a near-constant state of anxiety seems entirely plausible. The Department for Work and Pensions seems to see living and anxiety disorder as synonymous – at least if the PIP paperwork is anything to go by. Assessed on a points system, claimants are asked to prove that they struggle significantly in several areas of daily life – something I, one of the least anxious people you will ever meet, was able to do in five seconds. Do I need occasional prompting to socialise? Absolutely – that’s two points for me. Do I take longer to cook than most? That’s another two points. What about sometimes feeling unable to manage it all? Oh, at least once a day. That’s eight points – congratulations! Just eight points from the possible 72 entitles me to a standard daily living rate of £73.90 a week. Lucky Britain’s benefits bill isn’t out of control, isn’t it? (Total PIP spending is projected to rise from £26bn a year to £38bn within five years.) I’d better go and tell all my friends. They’d be mad to miss out on this giveaway. As always (and in all seriousness), this is not about the genuine claimants. It’s about the scammers. The opportunists. It’s about 33-year-old Catherine Wieland from West Sussex, who was given a suspended sentence last month after claiming £23,000 for an anxiety disorder so acute it kept her housebound. The same Wieland was later found to have made 76 beauty appointments and 60 pub visits; she was pictured clubbing, surfing and zip-lining in Mexico. It’s about the TikTok “anxiety coaches” with hundreds of thousands of followers; the ones who tell people exactly how to cheat the most cheatable of systems. I don’t know what’s worse – the cynical opportunists or the people so desperate to be fragile that they get sucked into this fraudulent narrative. One thing is certain, though: until we stop rewarding the scammers and victimhood-chasers, until we start telling children early on that bouts of anxiety are a normal part of our daily mood fluctuations, we are actively creating a nation of Catherine Wielands. That’s enough to give any taxpayer acute anxiety"
Bad mental health has gone viral among a generation fixated on themselves - "We have dramatically expanded our definition of what counts as a mental health problem at exactly the same moment that young people appear to be experiencing more distress. Concepts that once described severe clinical conditions have crept outward to describe the merely unpleasant, the difficult, the uncomfortable. “Trauma” now describes a difficult conversation as readily as a life-altering event. “Toxic” applies to the mildly irritating as much as the genuinely dangerous. “Narcissist”, “red flag”, “triggered” – each a clinical term, and now a staple of everyday speech. Nick Haslam calls it “concept creep”. Haslam, a professor of psychology at the University of Melbourne, argues that harm-related concepts in psychology have quietly expanded their meanings over time, coming to encompass an ever-broader range of human experience. The result is a gradual lowering of the threshold for identifying experiences as harmful, a cultural sensitivity to suffering that, however well-intentioned, risks mistaking ordinary hardship for pathology. This isn’t to say trauma, toxicity and genuine disorder don’t exist. They do. But when the language of serious mental illness becomes the default grammar for ordinary human difficulty, we should not be surprised when the diagnoses follow. What once described severe clinical conditions now encompasses experiences that previous generations would have called ordinary difficulty. The Diagnostic and Statistical Manual has expanded dramatically in the last few decades: from 106 diagnoses in 1952 to over 300 today. That is not simply medicine becoming more precise. It is the boundary between illness and normal human experience being continuously redrawn. And for a generation, the diagnosis is now the story they tell themselves about who they are. Mental health conditions have become part of our identity. While the well-intentioned mental health awareness movement set out to reduce stigma, it also created something significantly different: a new label for selfhood... What social media created was not just exposure to more distress but an infrastructure through which distress could be shared, validated, named and rewarded. Mental health identity didn’t just spread; it went viral. This shift is partly a reflection of the success of the awareness movement... this therapy culture has also, perhaps inadvertently, increased our preoccupation with suffering, training us to locate, name and monitor distress in ways that may heighten rather than relieve it. Gen Z are by measurable behaviour the most health-conscious generation in history. They are less likely to drink, to smoke, take drugs or have casual sex. And yet they are also the most anxious. The self-optimisation culture that has grown up around mental health is an essentially individualistic pursuit – and the evidence suggests it may be precisely the wrong one. Harvard’s 80-year adult development study reaches a conclusion that sits badly with wellness culture: the single greatest predictor of wellbeing is not self-knowledge or healthy habits. It is the quality of your relationships. A generation spending more time alone monitoring its own mental states may be doing everything wellness culture asks of it, and precisely the thing most likely to make it miserable. When nearly two-thirds of teenagers are classified as having a mental health condition, the category loses meaning and the young people who are genuinely, severely unwell risk getting lost in the noise. ADHD diagnoses now stretch to an eye-watering decade-long wait for NHS care. When we’re too busy diagnosing and pathologising, we fail at understanding the genuine suffering at the core of these statistics. The mental health awareness movement taught a generation to identify their distress. What it didn’t teach them is that merely naming something is not the same as treating it or even accurately diagnosing it. Not all pain is a disorder. And the oldest cure for human unhappiness cannot be downloaded, diagnosed or optimised. It is, and has always been, other people."
Clearly, the solution is even more funding to expand the mental health-industrial complex
