Wes Streeting’s remark that mental health conditions were being “overdiagnosed” came during a discussion of disability benefit cuts. What a convenient explanation for cutting benefits! If the growth of distress can be attributed to an excess of diagnoses, the government needn’t answer for the conditions producing that distress; it can turn its attention to the supposed failings of the people asking for help.
Streeting later apologised. Now the review he commissioned nine months ago, led by Professor Peter Fonagy and examining mental health conditions, autism, and ADHD in England, has supplied something more substantial than an apology. The steep rise in anxiety and depression is real. The suffering is real. The comforting picture of a generation inventing illnesses to escape ordinary responsibilities cannot explain what the review has found.
Let us examine the conditions which this accusation conveniently passes over. The review identifies disruption caused by Covid, financial and housing insecurity, competitive pressures at school and in social life, and the aggravation of those pressures by social media. These are conditions in which young people have to live, study, form relationships and attempt to establish some security. Calling their response excessive does nothing to remove the pressures.
Take housing insecurity. A young person may need a secure home and lack the money to obtain one. Very well, let us apply this philosophy of learning to endure life’s disappointments. Let the landlord endure the disappointment of not receiving the rent! At once our preachers of resilience will discover that money has to be found, bills have to be paid, and practical arrangements have to be made. Exactly. They have discovered why the tenant was anxious.
Sure Start services and youth clubs have been swept away. The review finds less belonging and more loneliness. Those who prefer to debate the supposed weakness of the young ought to explain how people are to find company in a club that’s been closed, or obtain support from a service that no longer exists. Let them begin with that explanation, before telling us how much better the young would fare if only they had stronger characters.
Fonagy himself experienced severe depression as a teenager in 1960s London. Of young people today, he writes: “I am in awe of their courage. Young people are contending with more powerful forces than I ever faced. They are not fragile. They are outnumbered.”
Meanwhile, a diagnosis carries enormous weight in obtaining treatment, school support or disability benefits. Make people prove their need, attach this importance to a diagnosis, and then reproach them for seeking one! One begins to suspect that the objection isn’t to the diagnosis at all, but to the assistance which may follow.
Sixty-four weeks for an NHS diagnosis! Those who can pay for a private one have a better chance of getting support, the review tells us. The same difficulties, the same need for help, but how much more readily that need can be established when the family has money!
Fonagy acknowledges the risk of overdiagnosis. Evidence that it is occurring at scale is another matter: he finds none. He does find plenty to criticise in the growth and reliability of unregulated private assessments. Perhaps those so alarmed about unreliable diagnoses could spare some of their suspicion for this business.
Fonagy proposes earlier assessment of need and prompt support, with less dependence on diagnosis. Very good. Let us have the staff and services to provide it. The same review warns that services are overwhelmed, yet here we encounter another familiar diagnosis: the cost to the taxpayer is unsustainable.
Here is a way of making the figures look better: withdraw public help and leave a relative to do the work unpaid. Where no relative can do it, let the person go without. The Treasury will have saved money. We invite the patient and the exhausted relative to admire the saving.
There will be further occasions for such arithmetic in the Milburn review of youth employment, the Timms review of disability benefits and the government’s SEND changes. We needn’t wait for another review to establish that a person whom capital cannot employ must nevertheless eat. The worker who cannot work hasn’t forfeited a claim on the wealth which the working class produces.
We want the working class to take possession of the housing, the wealth and the means of providing care, and to spend that wealth on its own people, including those who cannot work. Let homes be built and allocated for those who need them; let assessment and assistance be publicly provided, with the staff to deliver them, so that families don’t have to purchase a better chance of help. The rent collector and the private assessment business will call this an attack on their property. They will be right.
The review warns: “Continuing as we are is not sustainable.” Then let that warning reach the owners as well. The young have been told often enough that they must change.
