As a former consultant occupational psychiatrist to the Metropolitan Police and a contributor to the Black & Frost report, ^{Reference Black and Frost1} I would like to point to the basic flaw in the paper by Gilbody et al. ^{Reference Gilbody, Bower and Rick2}

In Gilbody et al's account of ‘depression in the workplace’, they take ‘depression’ as a given, requiring no further explanation, yet there is currently no psychiatric category so bloated and subject to overdiagnosis. My experience of 900 assessments of individuals at the Metropolitan Police, 99% of whom were certificated as being ‘off sick’ with depression or one of the other ‘common mental disorders’, showed that the psychiatrisation of non-specific symptoms led routinely to unduly prolonged sickness absence and thus unnecessary disability. ^{Reference Summerfield3} Sickness absence was strongly associated with workplace problems and other situational stresses: dislocation to a psychiatric arena frequently paralysed the practical problem-solving that would have normalised the situation in timely fashion. I found that National Health Service (NHS) mental health services were disconnected from the occupational aspects of patients’ lives, and saw diagnosis and treatment as having a life of its own. Antidepressants and periodic out-patient appointments did not seem a model that got many people back to work. Naturally, I support Gilbody et al's advocacy of closer relations with the workplace but NHS services will continue to be as much part of the problem as of the solution without a review of the narrowly biomedical culture of much psychiatric practice.

Last, Gilbody et al see hope in the Layard Improving Access to Psychological Therapies (IAPT) programme. It is laughable hubris for the profession to imagine that large numbers of very heterogeneous people, many of whom have been out of the workplace for years, can be gathered together under the rubric of ‘common mental disorder’ and restored to full productivity via a few sessions of talk therapy.