Are they over-diagnosing or being underhanded?

Note: I speak in cis-gendered terms in this piece due to the statistics I've found.

In December 2025, Health Secretary Wes Streeting launched an independent review into rising demand for mental health, ADHD and autism services. The headlines were telling: Overdiagnosis. Too many labels. Are we pathologising normal human experience?

The timing couldn’t have been more convenient. Just days after Keir Starmer announced upcoming reforms to welfare, Streeting launched a review ostensibly about clinical accuracy but framed in the context of 4.4 million working-age people now claiming sickness or incapacity benefit, up by 1.2 million since 2019.

The question has been circulating in the media for a while now, and on the surface, it may sound reasonable. Surely if diagnoses are going up, something must be off, right?

Or is it that we’re asking the wrong question entirely?

The numbers that sparked the “panic”

In 1993, 15.5% of 16 to 64-year-olds had a common mental health condition, compared with 22.6% in 2023-24. Sertraline prescriptions increased by 685% between 2010 and 2023. And it's not just antidepressants. ADHD prescriptions rose by almost a quarter between 2023 and 2024. Thirteen times more people were waiting for an autism assessment in September 2025 compared with April 2019. These are significant jumps. So surely, it's not unreasonable for policymakers to ask what's driving them.

The thing is, Streeting’s review doesn't just look at one condition. It clumsily lumps together mental illness (anxiety, depression) with neurodevelopmental conditions (ADHD, autism) – conditions with entirely different diagnostic pathways, treatment approaches and underlying causes. A convenient conflation. Because when you blur the lines between "feeling anxious" and "having a neurodevelopmental condition," it becomes much easier to suggest that everyone's just being oversensitive, that maybe we've gone too far and that we can't afford to keep supporting this many people.

The welfare cuts we’re not supposed to notice

More than half of the rise in 16 to 64-year-olds claiming disability benefits since the pandemic is down to more claims relating to mental health or behavioural conditions. Some 1.3 million people claim disability benefits primarily for mental health or behavioural conditions, which represents 44% of all claimants.

The review wasn't launched because clinicians are worried about diagnostic accuracy. It was launched because the government is worried about the welfare bill. Starmer has said the system is "trapping people, not just in poverty, but out of work". Streeting has talked about people being "written off". What they’re really saying is that they think too many people are claiming benefits, and something must be done.

The "overdiagnosis" narrative offers political cover. If mental health conditions are being over-diagnosed, then maybe some of those benefit claims aren't legitimate. Maybe people just need to try harder. Maybe, if we tighten the criteria, make diagnosis harder to access, question people's experiences more, we can reduce the welfare bill without it looking like we're abandoning vulnerable people. So, austerity dressed up as clinical rigour.

What's driving the numbers

What they don’t want to admit, or address, is that mental health in this country has genuinely worsened. The prevalence of common mental health disorders among adults aged 16-64 rose from 17.6% in 2007 to 22.6% in 2023/24. Among those aged 17 to 19, 10% had a probable mental health disorder in 2017, rising to 23% in 2023. The ONS found that the prevalence of moderate or severe depressive symptoms among adults in Great Britain rose after the start of the pandemic, from 10% before COVID to 19% by June 2020 and 21% by January to March 2021.

This isn't happening in a vacuum. We've lived through a global pandemic. A housing crisis. A cost-of-living crisis. More than a decade of austerity that gutted social services, youth services, mental health support. The ONS notes that rates of depression were higher among those who found it hard to afford housing costs or energy bills, and higher among renters than homeowners.

So yes, more people are experiencing mental health problems. Because more people are struggling. Because life has become materially harder for millions of people, and mental health doesn't exist in isolation from the conditions we live in. And instead of interrogating the cause, they’re basically gaslighting us with an overdiagnosis narrative.

The ADHD example

ADHD is a particularly instructive case study. It's been held up as the poster child for "overdiagnosis”, but the evidence tells a very different story. It's been historically viewed as a “boys'” disorder – loud, disruptive and impossible to miss. Girls with ADHD often presented differently. Quieter, more internalised and inattentive rather than hyperactive. They sat at the back of the classroom, didn't cause trouble and fell through the cracks entirely.

Some studies estimate that between 50 and 75 percent of girls with ADHD are missed. Girls are diagnosed on average five years later than boys. So by the time many of these girls grew into women, they'd spent years believing something was fundamentally wrong with them. They'd been told they were lazy or too sensitive. Some had been diagnosed with anxiety or depression – conditions that were real, but that sat on top of an undiagnosed ADHD that nobody had thought to look for. For these women, a diagnosis was the first time their experience made sense.

And it wasn't just women. The NHS's own Independent ADHD Taskforce (which published its final report in November 2025) concluded that the prevailing issue in the UK is not overdiagnosis – it's significant unmet need. Only around one in nine adults with ADHD have a formal diagnosis. Waiting times for assessment in some parts of the UK have reached ten to fifteen years. The Taskforce found that only 15 percent of adults with ADHD were receiving medication, despite evidence that 70 to 90 percent would benefit from it. We are, by any clinical measure, under-treating this condition. Not over-diagnosing it.

The backlash

When a headline says mental health conditions are being over-diagnosed, the people it cuts deepest are often the ones who fought the hardest to get a diagnosis in the first place. It sends a message. Whether it's intended or not (it is): “Maybe you don't really have it. Maybe you're just looking for an excuse.”

I've written before about how the language we use around mental health matters, how the words we choose can either open doors or slam them shut. This is one of those moments. A conversation that, in the hands of the media and politicians with a welfare bill to cut, can very quickly become something that makes already vulnerable people feel less safe seeking help.

The University of Liverpool put it well: what looks like overdiagnosis is really a system struggling to provide continuous care. The problem isn't that too many people are being labelled. It's that the labels are being handed out without the support that should come with them – and then the labels themselves are being blamed for the mess.

A diagnosis can be life changing. It can be the thing that finally gives someone a framework to understand themselves, stop blaming themselves and access the support they need. But a diagnosis can also become a ceiling if it's treated as the end of the conversation rather than the beginning. And in a system where diagnosis-only services are the norm and integrated support is the exception, that's exactly what it becomes for a lot of people. So the question shouldn't be: are we diagnosing too much? It should be: are we understanding well enough?

The review, the rhetoric and what needs to change

Wes Streeting's independent review, led by Professor Peter Fonagy and due to report in summer 2026, will hopefully do more than generate headlines. At its best, it could lead to genuinely better, more consistent, more equitable assessment and care. At its worst, it becomes another reason for people to hesitate before asking for help.

The evidence, as it stands, is not ambiguous. Mental health has worsened. Diagnoses have risen because distress has risen. ADHD is under-diagnosed and under treated. Anxiety and depression disproportionately affect people in poverty, people struggling with housing insecurity, people in the most deprived areas of the country. The system is under enormous pressure, yes, but not because people are gaming it, because decades of underfunding and inconsistent care have left a backlog of unmet need that is finally, belatedly, coming to light.

What we need isn't fewer diagnoses and more scepticism. It's better assessments that are more thorough, compassionate and equitable. And, crucially, diagnoses that come with actual, ongoing support attached. Until that changes, the debate about whether we're over-diagnosing will keep drowning out the people who still can't get diagnosed at all. And that's the part of the conversation that deserves far more headlines than it's getting.