The UK Mental Health System Is Letting Young People Down

According to the National Institute for Health and Care Excellence (NICE), antidepressants like Sertraline can induce mania or hypomania in people with undiagnosed bipolar disorder. For me, experiencing mania after starting sertraline was one of the clearest indicators that bipolar disorder might be part of my picture.

Sertraline, a common SSRI prescribed for anxiety and depression, is indeed known to sometimes trigger manic episodes in individuals with underlying bipolar disorder. A 2021 study published in the Journal of Affective Disorders reviewed over 200 cases of antidepressant-induced mania and found that up to 15% of people prescribed SSRIs without a prior bipolar diagnosis experienced mania or hypomania, often because their bipolar disorder had not been identified before treatment began. Furthermore, another study from 2020, published in the Bipolar Disorders Journal, underscored this risk, particularly when patients are misdiagnosed with unipolar depression or anxiety instead of bipolar disorder. The authors of that study argued that better early screening could prevent these adverse reactions.

My experience isn’t unique. 

The NHS Digital report in 2023 disturbingly showed that nearly 250,000 children and young people in England were either turned away or redirected without receiving proper treatment. Many faced long waiting times, sometimes stretching to four years for an initial appointment. An FOI investigation in 2023 further highlighted a "postcode lottery" in child and adolescent mental health care, with desperate young people waiting up to four years for help. Average waiting times for a first appointment in England reached 21 weeks in winter 2021, and almost three-quarters of English trusts reported at least one young person waiting over a year to be seen.

The Mental Health Foundation’s 2022 report pointed out that young people trying to get help for self-harm and suicidal thoughts often don’t meet CAMHS’ “threshold” criteria, meaning they’re denied access to the care they urgently need. Accounts from frontline staff confirm that even a 17-year-old with a history of self-harm, found attempting suicide, might be told they "didn’t meet the threshold". The report also noted that children’s distress that doesn’t appear “severe” or “visible” is frequently overlooked, even though it can be just as dangerous.

Bipolar disorder often begins in adolescence or early adulthood, with the UK Bipolar Disorder Society estimating that half of all cases start before age 25. Early diagnosis and treatment are crucial to prevent harm, reduce hospitalisations, and improve long-term outcomes.

Yet, studies show that misdiagnosis is common. Research from 2019 by the British Journal of Psychiatry found that, on average, people with bipolar disorder wait 6-8 years after symptoms begin before getting a correct diagnosis. During that time, many are treated incorrectly, sometimes with medications like SSRIs that can worsen symptoms. 

When I told professionals I related to Borderline Personality Disorder (BPD) and bipolar, I wasn’t just guessing; I had done my research. But professionals often avoid giving those diagnoses to teenagers. They worry about labels being harmful, and it's true that labels can carry stigma. Clinicians report a historical reluctance in the UK to diagnose personality disorder in young people, partly due to concerns about developmental changes in adolescents and the perceived stigma associated with the diagnosis.

However, as I know firsthand, and as experts have clearly stated, refusing to give a diagnosis can stop young people from accessing care that actually helps. It can lead to inappropriate treatments or no treatment at all. While some adults find a BPD diagnosis validating and a "turning point" for recovery because it provides access to evidence-based treatments, others describe discrimination, feelings of self-judgement, rejection, and hopelessness. Ultimately, the harm of not being believed, not getting the right treatment, and being left on your own with symptoms that are overwhelming and sometimes dangerous can be far greater than the perceived harm of a label.

Indeed, the mental health system in the UK is heavily diagnostic, meaning that formal diagnoses are often essential for professionals to communicate effectively about a patient's needs and to "pull services in" for funding. This puts clinicians in a difficult position, sometimes forcing a "medical vs. psychological" battle within teams where the necessity of a diagnosis for access can overshadow deeper, more nuanced understandings of a young person's distress. Clinicians themselves acknowledge the immense pressure and "weightiness" of deciding whether to diagnose, especially given that withholding a diagnosis could mean a young person attracts multiple, inappropriate diagnoses instead.

I think Dialectical Behaviour Therapy (DBT) could help me. I’ve read about it, and I know it’s used for people with BPD. NICE guidelines explicitly recommend a comprehensive DBT programme for women with BPD for whom reducing recurrent self-harm is a priority. This evidence-based modality, developed by lived experience expert Marsha Linehan, often involves both individual and group therapy with skills practice.

But to get it, I need a formal diagnosis. And getting that is like trying to unlock a door with a key no one will give you. Some people have said that their whole life changed after getting diagnosed and accessing DBT. Yet, the difficulty of accessing these crucial therapies through public services means that others have to go private, which isn’t an option for me. In some severe cases, families have been told by GPs to find private support, even if it means borrowing money, because CAMHS won't accept a child unless they've made "two viable attempts on their own life". I’ve already seen how services are stretched, and how even when you’re asking for help, you can be told you’re fine just because you’re not screaming. This situation is widespread, with over 80% of community CAMHS reporting they are unable to meet current demand.

Not everyone shows symptoms the same way. You can appear to be calm and still be deeply unwell. You can be articulate and still be in pain. You can look like you’re coping and still be suffering. I wish more professionals understood that. The Mental Health Foundation's report clearly states that distress that doesn't appear "severe" or "visible" is frequently overlooked, despite being just as dangerous. 

Systemic change is desperately needed. While the NHS Long Term Plan (2019) pledged to improve children's and adolescents' mental health services, including reducing waiting times and increasing early intervention, progress has been slow, and funding remains inadequate. The 2023 Health and Social Care Committee report criticised CAMHS for failing to provide accessible care and recommended urgent reforms, including better training for staff to recognise complex conditions like bipolar disorder early. This report also called for each NHS Trust to appoint a Personality Disorder Lead and ensure that patients are not denied mainstream services based on diagnosis alone but instead receive suitable adjustments to support their access to care.

At this point, I have no trust for the system and choose not to pursue matters further.