Will A Review Into Mental Health Fix A System In Crisis?

Will A Review Into Mental Health Fix A System In Crisis?

From the Times and the Sunday Times, this is the story. I’m Manvine Rana. Today, the government is launching an independent review into what’s driving rising demand for mental health, ADHD, and autism services. As waiting lists have ballooned across the NHS with the average wait time now for an adult ADHD diagnosis at 8 years, so too have the number of critics for the way the current system treats those with mental health issues and neurodeiversity. There is a crisis of overdiagnosis of children with neurodeiverse issues. ADHD is the fashionable disorder of the day. social anxiety. We used to call it shy. Even the health secretary Wes Streeting has weighed it in. Mental well-being, illness, it’s a it’s a spectrum, right? And I think too many I think there’s definitely there’s an overdiagnosis, but also there are too many people being written off. [Music] The story today, the government launches a review into mental health, but will it fix a system in crisis? My name is Ellena Haywood and I’m the health editor at the Times. You’ve had a real exclusive today. A bit of a tip off. Tell us what you’ve learned. Um, I’ve heard that West Streeting, the health secretary, is planning to announce a big independent review into mental health services in England. And as part of this, it’s going to try and get to the bottom of why mental health problems are really on the rise, why more people are getting diagnosed with anxiety and depression, and particularly this huge demand we’ve seen for ADHD and autism services. And what do we know about how this inquiry will be conducted? The inquiry is going to be led by an independent team of experts um led by a man called Professor Peter Fongy who is a clinical psychologist. He specializes in children’s and young people’s mental health and he’s joined by other leading psychiatrists such as Sir Simon Wesley who was formerly the chair of the Royal College of Psychiatrists and they said they’ll consult patients, psychiatrists, doctors, mental health leaders and try and get a big broad picture from across the country of what’s going on in mental health services. And do we have a sense of the timeline on this? Do we know how long this inquiry is likely to take? Um, they’ve not actually put a time scale on it. This sort of thing usually takes about 6 months. I think the government are quite keen to get the reforms out there and to get on with the action element. So, they’re going to make a series of recommendations and I think, you know, it will probably be tied in with other elements of reform that the government’s doing in areas like youth unemployment, which I know is due to report next summer. Right. So there’s an urgency around this question. It does feel like this review is predicated on the idea that the diagnosis for ADHD, autism, and mental health disorders have gone up significantly. Is that right? Have they? What are the figures? Yeah, there’s quite a lot of data in this area actually, and they all point to this big increase. So one thing we can look at is a survey the NHS do every year which shows how many adults have been diagnosed with mental health conditions and the latest one shows that in 2024 then 22.6% so nearly one in four adults had um a common mental health problem such as anxiety or depression. And so when you go back a decade it was 18.9%. So that’s quite a significant increase. And the biggest increase has been among young adults. And then at other stats as well, we can look at prescribing data. So for anti-depressants, 8.9 million people in England are now on anti-depressants. Wow. Uh yeah. And just a decade ago, that was less than 7 million. So it’s this really quite steep increase. And we see similar trends with other medication like ADHD medication. And there’s been an 18% hike in prescriptions for ADHD drugs between April 2023 and March 2024. So it does feel like the numbers have been soaring. Why is that becoming such an urgent priority for the government now? Is this about costs? Is it about welfare? Yeah, I think there’s quite a few reasons that it’s become an issue the government just can’t ignore anymore. So first of all, waiting lists are bad for everyone. They’re really bad for patients. If you’re a patient who suspects you have autism and you’re referred to a service and told you’re going to be waiting for years to see a specialist, that’s bad for you. Yeah. It’s bad for the government to have millions of people waiting to see psychiatrists in the community, waiting for support because they were elected on this key pledge to bring down waiting lists to transform the NHS. And I think they know that this is a problem they need to sort before the next election. And then also the cost element like you said, it’s kind of becoming increasingly clear that mental health problems are the driving factor behind a huge increase in welfare spending. That especially in the context of the budget last week, we’ve seen all this controversy around benefit spending, the number of people out of work and particularly because the biggest rise has been in young adults. Then you’ve got this generation potentially of people leaving school, leaving university, and you know, some people say they’re being written off because they feel too anxious to go into work in the first place. And that’s hugely concerning if you’ve got someone who could be spending their life working and contributing in taxes and are instead on disability benefits. And do we have a sense of how much the costs for government have gone up? Whether it’s in benefits and welfare or whether it’s just through some of the medications around some of these conditions. I think we can look at the forecasts that come out with the budget and from the Treasury and they’re all showing that spending on sickness and disability benefits is forecast to increase much much more than we even thought a couple of years ago. M the Treasury said that spending on sickness and disability benefits is to grow by 109 billion by 2030. Wow, that’s an extraordinary sum. It’s huge. And the stats as well show that mental health conditions and behavioral disorders such as ADHD are the most common condition affecting people claiming benefits. So it was four in 10 of recent disability benefit claimants said that mental health was the main reason and especially among younger people that is the key problem in terms of the cost. There was a really interesting figure in a recent report published by the government which showed that being out of work when you’re young costs 1 million in lost earnings over a lifetime and 1 million to the state in spending. Wow. Um, yeah. And there’s there’s been a nearly doubling in the number of 16 to 34 year olds off work due to mental health conditions over the past 5 years. So, that’s a really urgent problem that’s costing everyone. And is that what’s driving this review? Do we think there there’s an urgency about addressing those costs, about lowering them, looking at the state of the budget? Yeah, I think certainly the welfare spending issue has made this more pressing. Um, and we saw over the summer the government’s attempt to cut welfare spending collapsed. Um, Labour backbenches were not happy about it. And I wonder if this review might help lay the groundwork a bit for future reforms to the benefit system and you know persuade some of those Labor MPs of the need to not only reduce like tackle this problem of mental health claims but also provide support so that fewer people end up dependent on the welfare system. Yeah. So it could be seen as giving them the facts to support the sort of government’s desire already to try and lower the welfare bill. This review is is kind of designed to give them a narrative around that. Yeah, absolutely. And I think it’s it’s quite easy when you’re talking about welfare cuts to get trapped in a kind of oh no nasty people wanting to cut sick people’s benefits. But I think there’s another side as well which is if you can intervene early when people start having mental health problems by reforming the mental health system then people maybe don’t have to drop out of work. And so it’s it’s making a case for investment as well, I suppose, in mental health services, in things like talking therapies and in ADHD support in the workplace, things like that, so that people can stay in work rather than dropping out because the longer people drop out, the harder it is to go back. Yeah, absolutely. [Music] The government is launching a review into the rising demand for services for a number of conditions, mental health, ADHD, and autism. We focused on one. Well, I realized at 29 I had ADHD. But the reason I didn’t realize until I was 29 was because I didn’t fit the stereotype of a fidgety naughty boy. Dr. Tony Lloyd is a counseling psychologist and former CEO of the ADHD Foundation. He’s worked with the government on policy involving the condition. And for me then it was about learning to manage that in the best way I possibly could. How did it manifest for you? I mean, how did you feel ADHD affecting your life? I was hyperactive. I certainly had a hyperactive mind. I found it difficult to get to sleep. I was a workaholic and would experience frequent episodes of burnout. I could sometimes get emotionally overwhelmed, but I masked that very well. I had a successful career. I did achieve academically, but I recognized that I had to work twice as hard as everybody else and often found myself quite exhausted. But I never identified as disabled or disordered. And was it easy for you at the age of 29 to get that diagnosis? I couldn’t get a diagnosis at age 29. You were not allowed to get an adult diagnosis in the UK until 2013. Prior to that, it had always been classed as a childhood behavioral disorder, whereas it was recatategorized in 2008 and then in 2013 in the diagnostic manuals as a lifespan neuroype. So, you didn’t just grow out of it on your 16th birthday. And I got my formal diagnosis from a a psychiatrist colleague 12 years ago. And so, is it partly the reclassification? What’s happened? And why has there been this sudden explosion in the number of people being diagnosed with ADHD? I think there are several factors here. The first one is of course it was recognized as a lifespan neurotype only 13 14 years ago when people were able to get a formal medical diagnosis as an adult. The other key factor is historically there was significant gender bias in the diagnostic protocols which meant that we diagnosed four boys to every one girl. That’s now dropped to about three boys in every one girl. So more than half of the new adult diagnoses are for women because women were completely missed or invariably misdiagnosed, treated over many decades for anxiety, depression, sometimes given a diagnosis of bipolar disorder, but often the underlying cause was unidentified and unmanaged ADHD. And of course, the absence of any good quality public health information also contributed to that because there are enduring myths and stigma about ADHD being about naughty fidgety boys or some kind of oral weakness or ADHD medication being some kind of morality pill that made children behave, which of course is absolute nonsense. And the medication only lasts for 8 hours anyway. And this idea that life chances for people with ADHD were very poor as a result of poor educational achievement and therefore less soioeconomic independence. But now we know that 29% of all entrepreneurs for example have ADHD. We know that half of the legal profession identify as having ADHD or autism or both. We know that ADHD frequently co-occurs with dyslexia. So 43% of people with ADHD are also dyslexic and 40% of all millionaires identify as dyslexic and you were only ever allowed to have a single diagnosis right up until 2008. So even though we know all of these naturally occurring neurotypes like autism, ADHD, dyslexia, dyspraxia, dcalculia which have been around for as long as human beings have been around and that they are a natural expression of this wonderful diversity of human neurocognitive ability and potential and intelligence. But we live in a society and a culture and particularly an education system that is designed for some notional neuronormative child individual. So I think neurodiversity as a movement has been a triumph of lived experience over theory because the narrative in in the neurodeiversity paradigm is strengthbased rather than deficitbased. Well, before we get on to what the diagnosis means for people, is there a danger that there is misdiagnosis happening? Is part of that explosion an overdiagnosis of ADHD now by doctors who might be overcompensating for the fact that it wasn’t diagnosed so much before? It’s an interesting question and there are two elements to this. I think the first one we have to recognize is the World Health Organization says that global prevalence of ADHD is at least 5.9%. And in the UK that would equate to 2 and a half million either children or adults. In the UK only 270,000 children and adults combined have a medical diagnosis who access treatment from the NHS in the form of medication. So out of 2 and a2 million only 270,000 over diagnosis and are medicated. So it is not overdiagnosed. Point number one. Point number two, not everybody wants a medical diagnosis or needs one. And certainly most people with ADHD don’t want or need medication. But when we’re talking about potential misdiagnosis or overdiagnosis, the numbers actually just don’t bear that out. I think we’re asking the wrong question. The question should not be is it overdiagnosed because statistically it clearly isn’t. question should be is it a disability and is it a disorder because it’s a spectrum condition in the same way that autism, dyslexia, dyspraxia, discalculia are all on a spectrum and some people’s experience of ADHD can be much more acute and impairing than others and that figure you know the statistical idea from the WHO that five you know around 5% of of the population would have it in some form. Where does that come from? Where does that prediction come from? That is a metaanalysis of tens of thousands of research studies that have been done globally because in some countries prevalence is much higher than it is in others. In the UK, diagnostic prevalence has always been somewhere between 1% 2% at the most. So the 5.9% is is an average of global prevalence and we’re in the UK significantly below the diagnostic prevalence for the average 5.9%. Right? And when you’re diagnosing somebody with ADHD, what does that process look like? What is it you’re looking for? So um psychiatrist working alongside a pediatrician if it’s a child and a clinical psychologist would make an assessment based on their observation of how the child or the adult is coping with certain cognitive functions or skills or competencies. We’ve introduced very sophisticated computer-based cognitive screening tools like QB test which tell us whether the patient has a cognitive profile that meets the diagnostic criteria for ADHD. But we have to then look at the feedback both from the individual, their family, their teachers if they’re a child, look at school reports if it’s an adult to see whether this was something that was evident in childhood. Because what we then get is an overall picture of how ADHD is affecting them and their daily lives and their daily functioning. So when you are diagnosed, what changes? I mean what does why is it useful to have a diagnosis? Well, it can be an epiphany. Epiphany in the sense that there is something fundamental to the human condition that when we understand ourselves, it’s easier to learn how to learn and how to function at our best and how to succeed and achieve in the ways that we want to achieve and also how to belong and form relationships as a social species that enable us to thrive. Increasingly, it does seem as if the diagnosis of ADHD is becoming a political issue. Politicians are coming out and yeah, sadly. Is that partly because of funding? Why is it being talked about by politicians? Why are politicians worried that it’s being misdiagnosed? Okay. I think there’s a very real concern which I share that we’ve seen a significant escalation in the number of people particularly young people who identify or have had a medical diagnosis of ADHD or autism who are claiming personal independence payment and identifying as disabled and disordered and therefore more likely to be dependent on support from the state and I think it’s about one in five young people aed 16 to 25. So that is a very very real concern which is estimated it will cost us about30 billion pounds a year by the end of the decade and we all know that’s not sustainable. But here’s the issue instead of saying it’s being overdiagnosed and all the politicians know that it’s not. That is a categorical fact. They know it’s not. We’re asking the wrong question here. ADHD is an inconvenient truth. It’s always been underdiagnosed. The question we should be asking is, is it a disability? Is it a disorder? Neurodiversity is a reality. Neurode divergence is the social construct and it is premised on a notion of well, who is entitled, who is included, and who isn’t. [Music] So Elellanena, we’ve just heard Dr. Lloyd explain how actually statistically there doesn’t seem to be any overdiagnosis happening. You if you take the statistics that the WH its estimate for for how many people in the population are likely to have it, we’re probably still underdiagnosing in this country. But as you explained earlier, there is obviously for the government a very pressing question about both waiting lists and welfare costs which are out of control. Where does that leave us? I think where it probably leaves us is a future where diagnosis can be decoupled from the costs and from the welfare element. You know, if you are diagnosed with ADHD or autism, there’s nothing to say you need to not work. It’s more making sure that the support is in place so that yes, people can get a quick diagnosis if they need one and that diagnosis then leads to support in the workplace, maybe more flexible working. K Star actually gave a speech on Monday talking about the need to reform the welfare system and how too many people are being written off. We need to remove all the barriers which hold back the potential of our young people because if you’re ignored early in your career, if you’re not given the support you need to overcome your mental health issues or you’re simply written off because you’re neurodeivergent or disabled, then it can trap you in a cycle of worklessness and dependency for decades. that cost the country money is bad for our productivity and most importantly of all is a massive waste of potential. I think this idea that it’s one or the other. So it’s either oh it’s all fake people are faking their ADHD symptoms so they don’t have to work or that you know everyone needs diagnosis and and benefits is not necessarily helpful and it’s more bringing them together and saying if you put investment into NHS mental health services if you reduce the waiting lists then giving people that early intervention and really supporting them to get help means that they can then work and thrive and have the coping skills to get on in life in a way that maybe some people at the moment just feel they aren’t able to because they can’t access support. How do you enable them to live the fullest possible life? Yeah, absolutely. [Music] [Music] That was Ellena Haywood, health editor for the Times. And before that, you heard Dr. Tony Lloyd, counseling psychologist and former CEO of the ADHD Foundation. The producers today were Edward Drummond, Taran Seagull, and Michaela Arnison. The executive producer was Kate Lamble. Sound design and theme composition were by Malacetto. If you can do leave us a review wherever you get your podcasts. Thanks for listening. We’ll be back tomorrow.

Today, Health Secretary Wes Streeting is announcing an independent review into rising demand for mental health, ADHD, and autism services. Amid soaring welfare costs and long waiting lists, the government says the system needs to be transformed. But with Streeting previously claiming that some mental health conditions are ‘overdiagnosed’, are the right problems being tackled?This podcast was brought to you thanks to the support of readers of The Times and The Sunday Times. Subscribe today: http://thetimes.com/thestoryGuests: Eleanor Hayward, health editor, The TimesDr Tony Lloyd, counseling psychologist and former CEO of ADHD UKHost: Manveen Rana. Producers: Edward Drummond, Taryn Siegel, Micaela Arneson. Read more: Wes Streeting orders inquiry into mental health ‘overdiagnosis’Further listening: Is ADHD being over-diagnosed?Clips: Sky News, Channel 4 News, Parliament, The Sun, BBC.Get in touch: thestory@thetimes.comThis podcast was brought to you thanks to subscribers of The Times and The Sunday Times. To enjoy unlimited digital access to all our journalism subscribe here.

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