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Editorial

The Paradox of Mental Health: Over-Treatment and Under-Recognition

  • Published: May 28, 2013
  • DOI: 10.1371/journal.pmed.1001456
  • Featured in PLOS Collections

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Don't forget Dementia

Posted by vcoh on 21 Jun 2013 at 14:35 GMT

Comment on: The Paradox of Mental Health: Over-treatment and Under-recognition

As a specialist registrar in Old Age Psychiatry in the UK, I can identify with many of the issues in this editorial. In the USA, there is growing evidence of the potential over-identification of mental disorder documented around ADHD and other conditions starting in childhood, as described.

The picture in the UK certainly feels different as a clinician on the ground. Under-recognition and under-treatment appear more problematic than over-treatment in general. With regards to Dementia for example, 428,000 people are thought to have dementia but do not have a diagnosis in the UK: 54% (Alzheimer’s Society, UK, January 2013). If this were cancer the public would be outraged and health professionals would be called to account. This level of under-recognition, under-referral for a diagnosis and under-treatment is shocking. Medications for Alzheimer’s are cheap, effective and well tolerated, however large cohorts of the population are not able to access them due to under-recognition and under-referral to Memory Clinics.

The UK government have been championing Dementia since 2012 and the Prime Minister’s Dementia Challenge in March 2012 has certainly helped bring dementia care to the forefront. However, with an ageing population and therefore increasing rates of dementia expected, the health system as a whole needs to address the issues that dementia care is everyone’s business. Acute hospital staff need support to be trained to look after increasingly frail people and people with dementia in all wards (surgery or medicine). The Royal College of Nursing (UK)’s campaign ‘Commitment to the care of people with dementia in general hospitals’ is certainly aiming to address this (Royal College of Nursing, 2012).

The editorial clearly looks at Psychiatry as a whole and we would do better to address the individual specialties and conditions on a specific basis. My fear is that reports about over-recognition of ADHD, as an example, do much to damage the other psychiatric sub-specialties where under-recognition, under-referral, under-treatment and under-resourcing are far more of a concern.

1. Alzheimer’s Society 2013 www.alzheimers.org.uk
2. Royal College of Nursing 2012 www.rcn.org./dementia

No competing interests declared.