John Harris is misguided in his criticism of Wes Streeting’s review of UK mental health services (The right’s callous overdiagnosis bandwagon is rolling. Wes Streeting should not be on it, 7 December). While this review will inevitably examine questions of overdiagnosis, Harris is wrong to imply that Streeting’s main motivation is political. There is nothing unusual, of course, about ministers making decisions based on political considerations, but there is rather more to the review than Harris indicates.
It hardly needs restating that mental health services are grossly overstretched and underresourced, and an inquiry is necessary. This is a particular problem in child and adolescent mental health services (Camhs). When I was working as a clinical psychologist and involved in a Camhs autism diagnosis team 15 years ago, the waiting time for an autism assessment was around four to six months. Nowadays a waiting time of up to two years is common.
It is sensible that questions of overdiagnosis should be addressed in this review. It is the malevolent leaders of Reform UK who are jumping on to a bandwagon here, not Streeting. Overdiagnosis is now being discussed in sober and non-political terms by clinicians and researchers who recognise it as an important issue.
Nevertheless, Harris dismisses too quickly Suzanne O’Sullivan’s thoughtful book, The Age of Diagnosis. O’Sullivan argues persuasively that diagnosis should be conducted with a specific purpose in mind and make a practical difference for the patient. She explains that this is often not the case. Similarly, it is often unnecessary to fit somebody into a diagnostic category to offer them appropriate help. But some evidently find this hard to accept.
Dr Richard Hassall
Knaresborough, North Yorkshire
John Harris argues that concern about mental health overdiagnosis is a politically motivated austerity power play that will deprive vulnerable patients of desperately needed services. As chair of the American Psychiatric Association’s DSM-IV taskforce, which developed the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders in 1994, I am in a good position to contradict his assertion. Rates of reported psychiatric diagnoses have exploded recently due to a combination of: 1) confounding stress and distress with mental disorder; 2) ignoring the context in which symptoms occur; 3) the rise of internet self-diagnosis; 4) loose and fuzzily defined diagnostic criteria; 5) careless diagnosis (especially by GPs who have too little time to know their patients); 6) big pharma marketing; and 7) tying benefits too closely to diagnosis rather than level of functioning.
The result is a wasteful misallocation of scarce resources. The worried well and mildly symptomatic receive harmful, unnecessary treatments – while patients with severe illness are deprived of the treatment and services they desperately need.
Allen Frances
Professor and chair emeritus, department of psychiatry and behavioral sciences, Duke University
ADHD UK estimates that there are 2 million people in the UK with undiagnosed ADHD. Statistically, we are underdiagnosing ADHD, rather than overdiagnosing it.
I work in a primary school as a learning support assistant for special educational needs and disabilities. I am also a parent of a child with ADHD. ADHD is very common, and it is accepted by the National Institute for Health and Care Excellence that about one in 20 children has it. I don’t believe NHS services currently have the capacity to even assess one in every 20 children for ADHD, let alone provide support for them.
Natasha Fairbairn
Bristol
Have an opinion on anything you’ve read in the Guardian today? Please email us your letter and it will be considered for publication in our letters section.
