Clarity, not caricature, must lead the mental health debate

by Brian Dow, Deputy Chief Executive of Rethink Mental Illness and Chief Executive of Mental Health UK

Over the past week, public discussion on mental health has been loud, confusing and at times steeped in myth and storytelling. It would be easy to be left scratching your head about what is really going on. Is mental ill health on the rise? Are we over-diagnosing? Can people simply sit on benefits because they “claim” to experience a mental health condition?

This debate is not new and, it must be said, one that the unqualified often seem to enjoy, notably some members of the previous government who have made faintly ridiculous comments that suggest they imagine themselves both to be highly qualified practitioners and, like a fly on the wall in a GP surgery, confidently judging the private consultation taking place between doctor and patient. With the noise now threatening to drown out the facts, it is worth grounding the debate in what we actually know about our social security system, about workforce pressures, and about what the new independent review is really for.

You cannot “self-diagnose” your way to long-term benefits by declaring a mental health condition

This remains a simple but persistently repeated piece of hokum. Eligibility for disability or health-related benefits requires evidence, professional assessment and formal criteria. There is no pathway whereby someone can simply state they are unwell and automatically receive long-term disability benefits.

At Rethink Mental Illness, we hear every day from people who struggle to prove their condition, not people who breeze through the system. If anything, the barriers remain too high for many who desperately need support. The idea that self-identification automatically unlocks financial assistance is not just misleading, it actively distorts policy discussions at the very moment when clarity is most needed.

When people begin to describe themselves as experiencing a condition such as anxiety and/or depression, it is often because something in their lives has already become unmanageable. This affects work, relationships and daily life, often long before any formal diagnosis. In fact, for conditions such as bipolar disorder, there is an average 9.5-year delay between someone seeing a doctor about a symptom of bipolar disorder and getting an accurate diagnosis.

Self-identification may signal the beginning of a problem, but the system still demands that professionals confirm its severity.

The wider employment picture reinforces this reality. Sir Charlie Mayfield, the former chair of John Lewis, was recently asked by government to examine the issues surrounding ill health and disability in the workplace. His Keep Britain Working report acknowledged that long-term sickness, particularly related to mental health, has become a major driver of reduced workforce participation. But that does not mean people are “over-claiming”. It means people are overwhelmed.

If we want a productive workforce, we need workplaces that recognise mental health pressures rather than penalise them. It is striking that he reported not having spoken to a single employer who was not worried about mental health.

This is precisely why Mental Health UK now provides structured workplace training programmes. These give employers practical tools to spot early signs of distress, support staff appropriately and prevent avoidable sickness absence. The debate is not simply about diagnoses. It is about building environments in which fewer people reach crisis point in the first place.

Mental Health UK’s annual Burnout Report, which will be published again in January, shows that one in five workers feel persistently unable to cope. Early support is therefore not a luxury. It is essential.

The debate is being confused by conflating mental illness with neurodivergent conditions

It matters that we are clear about what we mean when we talk about mental health and neurodivergence, because they are not the same thing, even though they can and do overlap.

Neurodivergence, including autism and ADHD, describes natural differences in how people’s brains develop and how they experience the world. These differences are lifelong, and they are not mental illnesses. With the right understanding, acceptance and reasonable adjustments, many neurodivergent people can and do thrive at work, in education and in their communities.

Mental health conditions are different. They affect how a person feels, thinks and copes day to day, often bringing real distress and disruption to everyday life. Conditions such as anxiety, depression and bipolar disorder can affect anyone, at any stage of life. Some people will need clinical care and sustained support, alongside action on the wider social factors that shape mental health.

There is an important intersection between the two. Neurodivergent people are more likely to experience mental health problems, often as a result of stigma, exclusion, overwhelming environments and systems that do not meet their needs. That higher risk reflects the pressures people face, not neurodivergence itself.

So, no, it isn’t always crystal clear. When we blur the line between neurodivergence and mental illness, we lose the clarity that good policy and effective support depend on. They involve different experiences and often require different kinds of help. Being precise about those differences is not about labels. It is about making sure people get the right support, at the right time, in the right way.

Wes Streeting’s follow-up article showed leadership through humility and accuracy

Wes Streeting’s initial comments on the Laura Kuenssberg programme triggered debate, but his subsequent reflection in The Guardian last week was refreshing in its honesty. He wrote:

“I realise now that my view on mental health overdiagnosis was divisive. We all need better evidence, and I want this debate to be based on facts, not fear.”
And notably:

“Too many people are struggling without the support they need. I do not want anyone written off or denied help because the system can’t keep up.”

This is genuine leadership because it shows a willingness to adjust, listen and pursue accuracy. It really helps the temperature of public debate when senior politicians acknowledge their mistakes, and we should be grateful for that.

Professor Peter Fonagy’s independent review offers the most authoritative route to clarity

Commissioned formally by the Secretary of State, the review will examine prevalence trends across mental health, ADHD and autism, diagnostic thresholds and variations in clinical practice, social, economic and cultural drivers of rising demand, impacts on employment, education and the NHS, and options for earlier intervention and system reform.

It is led by Professor Peter Fonagy OBE, a globally renowned clinical psychologist, psychoanalyst and academic. As former Chief Executive of the Anna Freud Centre and one of the world’s leading thinkers on child and adolescent mental health, he brings decades of clinical, therapeutic and research experience. Having spoken to him directly, I know he is committed to engaging a wide range of voices and perspectives. Guided by evidence rather than conjecture, we should be confident that this review will provide clarity and, crucially, help ensure people get the right support at the right time.

GPs’ weekend comments on “overdiagnosis” were more nuanced than the headlines suggested

The article published by the BBC was, let’s agree, interesting. Of the 742 GPs surveyed via the Royal College of GPs, the largest single group felt mental health was being slightly over diagnosed. The next largest group thought it was about right. The third group, which drove the response it received, felt it was being over-diagnosed a lot.

What received far less attention is that a clear majority of GPs, 508 out of 742, said there was rarely or never enough good-quality mental health support available for adults in their area. Even more, 640 GPs were worried about getting young patients the help they needed.

Putting aside my own fairly grim experience with an overstretched south London GP surgery, it is also important to note that the vast majority of those approached did not respond to the survey at all. We can only speculate about their views. Moreover, the large group who believe there is not enough support available are arguably the most reliable witnesses. They are the ones diagnosing need, attempting referrals to secondary care and seeing at first hand where the system is falling short.

For more severe mental illnesses such as bipolar disorder and schizophrenia, diagnosis rests with secondary care professionals, not GPs. This is entirely appropriate given the specialist expertise required. Much of this clinical work is therefore already quite rightly beyond the scope of general practice.

A final word. Clarity over caricature

If we cut through the noise, Britain is not a country fabricating illness. It is a country grappling with growing distress, workforce strain and a social security system that is widely misunderstood.

At one end, some people may accurately describe themselves as experiencing anxiety, often driven by non-clinical factors such as debt, isolation or unemployment, while feeling uncertain about what support they need. At the other end, many wait years for an accurate diagnosis and endure torturous processes to access the right treatment.

Either way, evidence rather than speculation or personal prejudice must lead the debate. The goal should always be to secure the right support quickly and close to home, whether that support is clinical or social, rather than heaping stigma on people who are already under pressure. Above all, it is clarity over caricature that will allow us to become a nation that truly leads the way on mental health.