Mitchell and colleagues1 provide a helpful commentary bringing out many key issues regarding help-seeking for mental health support among young adults. I suggest most of their proposals are relevant to all ages; also that we need to tackle head on the problem in clinical practice of dichotomising at the individual level into those needing and not needing help according to whether a ‘disorder’ is present.
The evidence they provide that it is young adults who are less likely to gain support is limited.2 In our study, recently accepted by the BJGP,3 20–24-year-olds are the age group most likely to be referred and to access psychological therapy. Estimated prevalence of common mental health problems (CMHPs) according to the Adult Psychiatric Morbidity Survey starts at 13.8% for 18–19-year-olds, rises to 15.3% for 20–24-year-olds, peaking in 45–49-year-olds (20.6%). In contrast, annual referral rates to IAPT psychological services, as a proportion of CMHPs, peak in 20–24-year-olds (23.0%) and then decrease gradually from this point until 65–69 (9.7%); 18–year-olds (8.4%) are much lower and comparable with those 70–74 years of age (6.0%).
Mitchell and colleagues discuss stigma and self-reliance, but in my view they do not go far enough in addressing the current ‘best practice’ of designating individuals as either having or not having a ‘disorder’. This is a particular problem when considering the role of the GP, both in our roles at the interface between lay and medical worlds, and in promoting better mental wellbeing. We need a way of providing a range of support for stress and reduced function, which is more flexible: one that recognises specific problems such as irritability, low mood, social anxiety, and consequent problems such as study performance, arguments, avoidance, and substance use, without the need for a diagnostic label. In this way general practice can be an important part of the crucial public health challenge of preventing and alleviating mental distress and suffering, in ways helpfully suggested by Mitchell and colleagues, without having to always arbitrate between those who are ‘disordered’ or not.
- © British Journal of General Practice 2017
