Maybe there would be fewer mental health crises (Editorial, 25 April) if priority was given to earlier diagnosis and treatment. For example, the main complication of the chronic condition generalised anxiety disorder is substance misuse. If patients with it were identified early and had specialised therapy, many cases of secondary depression and substance misuse could be prevented.
Other conditions that may be missed or underdiagnosed include obsessive compulsive disorder, bipolar 2, somatisation disorder and early psychosis. Early treatment could modify the course of the illness, and patients who are less unwell have more scope to understand and contribute to their treatment plan. We try to treat patients with physical illness this way, so why not patients with mental illness?
Mental health problems don’t go away just because they are not diagnosed. On the contrary, if patients and families are not supported, the primary mental health problem can escalate, leading to self-neglect, self-harm, family conflict and wider community issues.
The problem does not just lie with services; late presentation can occur because of the stigma surrounding mental health conditions, because of fear of the possible side effects of treatment, or the well-documented risks of hospital admission. Stigma and risk can be mitigated by patient advocacy and choice. The “no decision about me without me” standard should apply as far as is possible with mental health too.
More expertise in mental health at the frontline and in primary care may help ensure that patients get the right treatment at the right time, and lead to better outcomes for all involved.
Dr Anna Stevens
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