‘Normal worries’ or mental illness? (Sick note Culture)

Elke Hausmann is a Salaried GP in Derby.

Some years ago I wrote a reflection on Lucy Foulkes’ book entitled: ‘What mental illness really is… and what it isn’t‘ for a GP appraisal.¹

A year later, having already written some book reviews for the BJGP life and BJGP, I was reminded of this reflection at a time when SSRIs were in the news again, this time in relation to doctors not having warned patients about the possibility of certain side effects including severe withdrawal symptoms. The implicit and explicit worry was that GPs overprescribing SSRIs for ‘Ordinary distress’. I went back to my reflection and found that in fact it was written already as if for a wider audience, and I didn’t need to change a thing before submitting it to the BJGP life.²

I am thinking about this review again in the light of recent announcements by the prime minister about taking sick note prescribing away from GPs, with the argument that ‘normal worries’ are being wrongly medicalized as mental illness, also using that to justify his proposal of cutting benefits from people who are signed of sick because of mental illness.³

I worried that somehow making a distinction between ‘ordinary distress’ and mental illness in my article was feeding into this rhetoric, as on the surface the prime minister made the same distinction.

I had to go back to my article to get some clarity on this. I was relieved to see that the final paragraph stated: ‘The author does not use this [the distinction between temporal human distress and mental illness] as an argument against offering treatment’.¹

The prime minister doesn’t say either that people in distress, whether it is due to mental illness or not, shouldn’t get help.³ The problem is, that help is often not available, as anyone with a cursory understanding of the current state of our mental health services will know. So to ‘offer’ non-existent treatment instead of benefits is disingenuous. Seemingly paradoxically, he uses the distinction between ‘normal worries’ and mental illness to justify cuts to benefits to all patients with mental illness, as opposed to physical illness. Because it sounds quite reasonable to suggest that people with ‘normal worries’ should just get on with it like everybody else, shouldn’t they? In his case, making this distinction somehow taints all mental illness as less worthy of support by the state than physical illness.

I think it has to be stated very clearly that any patient who comes to see a doctor because they are in distress, whether that is ‘ordinary human distress’ or mental illness, deserves support. The fact is that so many people are in distress because of distressing life circumstances (first and foremost related to austerity and poverty – this being ‘normalized’ is a big problem in itself) which can only be addressed by policy makers. When I have a patient in distress in front of me, it fundamentally does not matter if they have a mental illness or not – I treat them with what I have available to me.

Deputy Editor’s note: Join the discussion and also see –https://bjgplife.com/sick-notes-and-culture/,  https://bjgplife.com/what-drives-the-sick-note-culture-in-the-uk/, https://bjgplife.com/could-new-changes-to-the-fit-note-be-an-opportunity-for-primary-care/ and https://bjgplife.com/why-gps-must-not-lose-their-role-in-supporting-people-back-to-work/

1. Hausmann E, Books: What Mental Illness Really Is … (And What It Isn’t), British Journal of General Practice 2023; 73 (734): 416. DOI: 10.3399/bjgp23X734865
2. https://bjgplife.com/contribute/ [accessed 8/5/24]
3. Press release: PM to overhaul benefits system and tackle Britain’s “sick note culture” in welfare reform speech – GOV.UK (www.gov.uk) [accessed 8/5/24]

Featured photo by Hello I’m Nik on Unsplash