The Mental Health Dilemma

 

There is an "overdiagnosis" of mental health conditions, says Health Secretary Wes Streeting, where Generation Z are giving up on work, a new study suggests, with almost four in ten considering leaving their job and ending up on benefits, and many people already in that situation. We all probably know quite a few people who are playing the system; people who don’t work and probably could work, where the state is funding their lifestyle; and we all probably know people who are too unwell to work, and rely on justified welfare support, and are not getting anything like the support they need. Blanket solutions are problematic here, as every situation is a case by case.

The overdiagnosis issue is a complex matter to solve, because what we have here is a Type 1 and Type 2 error problem. A Type 1 error occurs when a diagnosis wrongly identifies someone as having a mental health disorder deeming them unfit for work, when they really could and should be working. And a Type 2 error occurs when there is a failure to identify a mental health disorder that is actually present.

By and large, the UK is a very risk-averse, interferingly cautious society, where we’d rather be awash with Type 1 errors to guard against Type 2 errors – that is, by analogy, we’d rather let off ten guilty people than see one innocent person go to jail (see my Blog post on Blackstone’s ratio). Type 1 errors are becoming ever-more predominate in many areas of society – from trans issues, to online censorship, to climate change policy, to free speech impediments, to race, equality and diversity policies -  and it seems clear that we are probably predisposing ourselves to increased Type 1 errors occurring in the domain of mental health, which are highly likely to be far more numerous than Type 2 errors. Additionally, because it’s both empirically harder and riskier to fail to diagnose a mental health disorder, or accuse someone of exaggerating a disorder, or suggest that their troubles could be overcome with more personal responsibility, we’d expect Type 1 errors to dominate.

If too many people are wrongly classified as unable to work, the results will be a shrinking workforce, higher welfare costs, lower productivity, and a greater burden on taxpayers. Some are saying we’ve already reached that point, and things are destined to get far worse if this continues. 

I don’t claim to have easy answers to these highly complex problems – but it’s certainly something that a nation shouldn’t be afraid of addressing, because the long-term consequences of this could be severe - not just in terms of economic stagnation and an overburdened welfare state, but also in how we perceive work, personal responsibility, and resilience. Ironically, of course, failing to address an overabundance of Type 1 errors by erring too heavily on the side of caution can itself be an example of the very same Type 1 error under examination. It's a feedback loop where the excessive risk aversion perpetuates the very problem it seeks to prevent. A Type 1 error of Type 1 errors.

Further Reading: Exploring Mental Health

Exploring Mental Health

Today is World Mental Health Day, which aims to “raise awareness of mental health issues around the world and to mobilise efforts in support of mental health”. Fair enough, I’m game, because mental health is important.

I nearly always welcome comments on my posts, but for this one, I actively encourage participation because diverse perspectives might be particularly valuable here, and I’d value your views on the subject.

Here I’m considering the UK’s perception of mental health and how we are performing in diagnosing negative mental health. Getting the right kind of mental health diagnosis at a population level is a complex problem to solve. Are we over-diagnosing or under-diagnosing mental health problems in the UK? And how would we measure that?

Let’s start with something we can probably say with confidence. Given that, throughout most of our modern history, very little regard was given to the subject of mental health, and given that most of the mental health problems people now encounter were undiagnosed and not even conceived of in our history, it’s a fairly safe assumption that we have under-diagnosed mental health problems in the past. But what about now?

Part of the consideration of under or over-diagnosis has to be about the definitions used. For example, the World Health Organisation (WHO) defines mental health as “A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” Under that definition, I’d expect most people to claim sub-optimal mental health, especially during many difficult periods of their life, because those criteria are big asks. 

Moreover, because of the numerous ways the UK has made a big mess of its own society, there are lots of impediments (some of them self-created) to an individual realising their abilities, coping with the normal stresses of life, working productively, and contributing positively to their community, that may not be proximally attributable to poor mental health. Perhaps we are under-diagnosing negative mental health in some cases and over-diagnosing it in others. Perhaps we are not focusing enough on the causes of positive mental health or doing enough to encourage these things. I don’t know.

And the places in which we are over-diagnosing negative mental health are bound to be extremely costly for UK society as a whole. There are likely to be many areas in life in which the cause of sub-optimal well-being is more directly attributable to things like not seeking the truth, failing to take proper responsibility for thoughts and actions, having too few close connections, an absence of positive people in life, life choices that negatively affect sleep, exercise, and diet, inadequate emotional awareness, and things of that nature. These are likely to increase anxiety, and may even lead to a diagnosis of depression, which in some cases might not be justifiably clinical.  

A successful diagnosis can give an individual access to medication, support and other resources they might not otherwise have had. A faulty diagnosis may deepen the problems further, create a stigma, and distract attention from more viable correctives. And there are obvious costs with false negatives (not diagnosing a mental health issue when it’s there) and obvious costs with false positives (diagnosing a mental health issue when there is a better explanation).

At some point in the future, I hope to address the complex landscape of mental health with a video series on my YouTube channel. But for now, I’d love to hear your perspectives in the comments section.