As a psychotherapist with child and adolescent mental health services, I welcome Wes Streeting’s change of heart on his comments about the “overdiagnosis” of mental health conditions, ADHD and autism (I realise now that my view on mental health overdiagnosis was divisive. We all need better evidence, 4 December). Political point-scoring has no place in public health.
By setting up this taskforce, Streeting acknowledges the complexity of the picture and that conversations must be led by research, where science and suffering can be held together.
The increase in reported mental health problems and neurodevelopmental diagnoses, and services not keeping pace, reflect what many clinicians see every day – people are in more distress and unable to access support. The suffering is not fake, nor is it a case of gen Z malingering.
Patients are struggling with what were once ordinary demands of life: school, work, relationships and family, complicated by the aftermath of Covid, with blurred boundaries between home and work, and life lived increasingly on screens. We still don’t understand the neurological impacts of Covid, but we can clearly see the social impact on children’s development and learning.
In this context, ADHD or autism can become an explanatory framework for a complex constellation of neurobiological factors and psychosocial difficulties.
A diagnosis can be clinically meaningful by reducing self-blame and shame that block people from seeking help, bringing those who might not otherwise attend services through the door, where professionals can identify differential diagnosis or address comorbidities.
I hope this review will lead to a holistic understanding of neurodevelopmental diagnoses, and to a multi-agency strategy to manage demand for services, with more investment in diagnostic aftercare to make sense of individual context and provide personalised support.
Our hope of understanding this is to begin from that more complex picture rather than a tug-of-war between the neuro‑affirmative and the hyper‑sceptical “it’s just a fad” positions.
Sagal Hassan
Child and adolescent psychoanalytic psychotherapist, The Soke
For too long, the narrative around autism and ADHD assessments has been shaped by ideology rather than evidence. Wes Streeting’s recent announcement is a much-needed intervention and first step in tackling overdiagnosis (Wes Streeting orders review of mental health diagnoses as benefit claims soar, 3 December).
Cowboy diagnostic providers – startups and online services with no qualified clinicians – are a real threat, diagnosing almost anyone they assess with little trace of scientific rigour. Such practices waste public money, undermine genuine diagnoses and cause real, long-term harm to their patients.
Conditions such as autism and ADHD are notoriously difficult to diagnose and only qualified, regulated professionals following clinical standards of care should be assessing patients for them. A diagnosis is permanent and carries significant implications, which means the children and adults being wrongly diagnosed will likely live with the consequences for the rest of their lives.
Instead of championing high diagnosis rates, as clinicians we should be promoting quality, evidence-based assessments that ensure the right people are seen at the right time and can access the help they need. This is an incredibly difficult and polarising issue, but the health secretary is right to make a stand.
Dr Lisa Williams
Founder and clinical director, The Autism Service
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.