Guyon Espiner: Are we over-diagnosing mental health issues in an era of awareness?

Opinion: We are at an inflexion point in our approach to mental health.

We’ve swiftly gone from never talking about it and viewing it as a binary proposition – “you’re fine, mate, but he’s crazy” – to marinating in mental health in mainstream and social media.

Around the world, the middle and upper class are eager for a diagnosis to put a name to the noise in their heads – whether it’s the cacophony of living in the mid-2020s or something more serious.

Two Oxford University research psychologists, Lucy Foulkes and Jack Andrews, coined the term “prevalence inflation” in a paper published last year. They argued that greater awareness of mental health was leading to more reporting of under-recognised symptoms, which they saw as beneficial. But they also found that “awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems”. That led people to “experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual’s self-concept and behaviour in a way that is ultimately self-fulfilling”.

Dr Foulkes also worked on a British study that followed 28,000 teenagers over eight years, hoping to show that mindfulness training would improve their mental health. But the results, released in 2022, showed mindfulness lessons led to an increase in depressive symptoms in the students most at risk for mental health problems.

Turning to neurodiversity, cases of ADHD are now exploding in the rich world. Between 2006 and 2022, prescriptions for ADHD medications increased tenfold in New Zealand, from 55 per 100,000 people to 556 per 100,000. Pharmac says demand for ADHD medicines has increased 140% in New Zealand in just the past two years (there is now a global shortage). Many New Zealanders not prepared to wait in the public health system are paying $2000 for a private diagnosis.

In Australia, prescriptions have doubled in the past five years. Interviewed by The Age newspaper, psychiatrist Professor Ian Hickie said he asked his colleagues: once people have paid $2000 to get to a clinic, how often do you say, no, you don’t have ADHD? “And the answer is, ‘not often’. "

Britain’s rise in ADHD medications has skewed towards the rich. Prescriptions for ADHD meds for the wealthiest 20% of the population grew twice as fast as for the poorest 20% between 2020 and 2023, according to reporting by the Financial Times in February.

Many health experts ­– and I couldn’t be further from that description – believe we are still under-diagnosing ADHD. I defer to their expertise, but I am sceptical. I am grateful to now live in a time where we can be more open about our mental health. But I suspect there may be a social-contagion effect as citizens and celebrities share their experiences on Instagram and TikTok (The Age estimated #ADHD had 36 billion views as of March 2024).