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Britain is a country known for its restrained restraint, but it is quite open when it comes to mental health. Britons are more inclined than people in any other rich country to think that mental illness is just like any other illness. Only Swedes are more accepting of the idea that someone should not be disqualified from public office because of a history of mental-health problems.
The importance of good mental health has been vigorously promoted by everyone from the Princess of Wales to opposition leader Sir Keir Starmer; employers preach well-being. Britons were once encouraged to hide their feelings; now they are urged to seek support.
Most of the world’s rich countries are struggling with rising rates of mental health problems, especially since the Covid-19 pandemic. But in the UK the numbers are shocking. Around 4.5 million British citizens were in contact with mental health services in 2021-22, an increase of almost 1 million over the past five years. No other European country has seen such a high increase in the use of antidepressants over the past decade.
A 2023 National Health Service (NHS) survey found that one in five 8- to 16-year-olds in England have a probable mental disorder, up from one in eight in 2017. Among 17- to 19-year-olds, the number has risen from one in ten to one in four. The number of people unemployed due to mental health problems has risen by a third between 2019 and 2023.
It’s great that people don’t feel like they have to keep it under the rug and that suffering from mental illness is real. Awareness about mental health has reduced the stigma around some conditions and highlighted that many Britons have unmet needs. But awareness has also caused harm.
For all their good intentions, campaigns aimed at raising awareness are leading some people to associate normal responses to life’s difficulties with mental-health disorders. Specialised treatment leads people to seek diagnoses and unnecessarily medicalise problems. The need for treatment for those with mild illnesses competes with the care of those who are most severely afflicted.
Start with the idea that mental health has become a catch-all term. The sheer number of people who say they have a disorder is a wake-up call. Around 57% of university students claim to have a mental-health problem; more than three-quarters of parents with school-going children sought help or advice about their child’s mental health in 2021-22.
In surveys, Britons are increasingly describing grief and stress as mental illness, changing the way illness is understood. Most conditions do not yet have objective biomarkers, so self-reported symptoms are very important in official statistics and diagnostic processes.
People have an incentive to label mild forms of stress as a disorder. More than a quarter of 16- and 18-year-olds in British schools in 2022 were given extra time on official exams because of a health condition. Evidence of a mental-health problem can unlock welfare payments. Certification doesn’t require an NHS doctor: plenty of private clinics are willing to provide it.
Firms may prefer to label stress a disorder rather than admit that working conditions are poor (the World Health Organisation implies that the best way to protect mental health in the workplace is good management). The highest rates of diagnosed depression are among the poorest in England, but the government probably prefers to prescribe antidepressants rather than try to solve poverty.
Using mild stress as therapy may not benefit patients. A study of mindfulness courses in 84 British schools found that general teaching was just as good for mental health. But overdiagnosis does the most harm to those who need help the most.
In theory, the NHS is able to prioritise patients by need. In practice, a service that has been chronically understaffed and poorly organised is struggling to cope with rising demand. The number of young people coming into contact with mental-health services has grown at more than three-and-a-half times the rate of the workforce in child and adolescent psychiatry. The 22% increase in the overall mental-health workforce in the five years to 2021-22 can never be matched by the 44% increase in referrals for all patients. At least 1.8 million people are waiting for mental-health treatment.
Rising demand is driving staff to private practice. NHS doctors, exhausted from dealing with the most serious cases, can earn up to £1,000 ($1,265) per session to assess attention-deficit hyperactivity disorder. The NHS has only 6% more consultant psychiatrists than a decade ago, while emergency medicine has 86% more consultants.
Police address this problem to some extent – officers in England spend around 1 million hours a year with mental health patients in accident and emergency departments – but this is not treatment. Despite increased awareness of mental health conditions, outcomes for people with severe mental illnesses, such as bipolar disorder and schizophrenia, are getting worse; they die 15-20 years earlier than the rest of the population, a gap that was growing before Covid-19 and has widened further since.
Many changes are needed to rethink Britain’s approach to mental health. More money must be spent on research so individuals can be treated appropriately; mental disorders absorb 9% of England’s health budget but 6% of medical-research funding. More attention must also be paid to the social causes of mental illness. Earlier this year the government shelved an ambitious plan to look at the underlying context of mental disorders, from poverty to isolation; that plan should be revived. More time and effort must be devoted to those most in need of help; reforming the Mental Health Act, an outdated law that makes mentally ill people feel like criminals, would be a start.
Cause and Effect
Above all, the UK needs to avoid the mass medicalisation of mild forms of distress. Pushing people into an overstretched healthcare system is having predictable consequences. All suffering should be taken seriously, but a diagnosis is not always in one’s best interests; recent research found that when volunteers learned to suppress negative thoughts they were happier. The UK has become more compassionate about mental health. It also needs to become more considerate.
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