Horizon: How Mad Are You? Professionals diagnose mental health

The BBC recently set up a reality TV-style challenge for mental health professionals to diagnose members of the public. Andrew Mickel asks whether this approach was ethical

The BBC’s Headroom season on mental health has been spearheaded by a range of celebrities who swerve from the sublime (Stephen Fry) to the ridiculous (Alistair Campbell, Michael Portillo, Ruby Wax).

Horizon’s “How Mad Are You?” on BBC2 last Tuesday was the first time that Joe Public got a look in, and as befits our times, the only way a non-celebrity could feature was to film them locked up in a house performing tasks.

Hever Castle in Kent may not be the Big Brother house but this was still reality TV, complete with a judging panel who were trying to determine which five of the 10 housemates – sorry, “participants” – had histories of mental health problems. Despite the problems using such a format, it did a better job of communicating a clear message than a worthy documentary could muster: just because someone has been diagnosed with a mental illness doesn’t mean they’re not “normal”.

Willing contestants

The programme benefited from its willing contestants. Take Dan, unmasked as the participant with obsessive compulsive disorder (OCD) after his queasy reaction to shovelling cow dung. He seemed mildly annoyed to have been spotted but was still a great ambassador for living with OCD and getting on with life. He may not have made OCD cool – we have Monk (the US TV detective) for that – but he’s done his part.

The programme was successful in depicting how the line between mental health problems and eccentric character traits is a tricky one. But it struggled with showing how hard it can be for experts too.

The programme was a contrived situation that forces the watching experts to squeeze the subjects into various mental illness-shaped boxes. For a show that aimed to bring the real face of mental health to the public, that’s an issue, says Kam Dhillon, head of research at the Mental Health Foundation.

“Diagnoses are complex they aren’t just a series of observations. These are important as part of the diagnosis process but they are small and limited,” he says. “I was glad there was a pop format that was being used to communicate something. But I don’t think it communicated much about care.”


The risk is to present the idea that mental health services want to institutionalise you if you so much as sing to yourself in Sainsbury’s. There was a real need for disclaimers that the experts’ role was TV gloss and not medical practice.

Presenting science in such a populist format created other issues. Dhillon says: “I don’t know how the ethical issues were being managed but somewhere they would have had to be tested for psychological stability [to be on the show]. But did they get the chance to be edited out of a task? That issue of consent is crucial.”

The programme also fits the pattern with other shows in the BBC’s Headroom season: they have all been about people who have recovered. This is primetime TV’s one big chance to tell the audience about mental illness, so why not feature people who are still ill rather than only those in recovery?

Show Recovery

Shaun McNeil, a former service user with depression and on the governing board of Vox, a Scottish mental health service user forum, says: “It depends on how you define ‘recovery’. The guy with OCD was still struggling with it. I would say recovery is about managing well despite the symptoms of your mental health problem. I don’t think the show is detrimental to people at a more serious stage of their illness.”

Still, these were fairly unavoidable side-effects of the format, and given that it pulled in two million viewers on a Tuesday evening on BBC2, it’s done its job. And the experts are happy too: both McNeil and Dhillon cautiously welcome the show (with the proviso that the second episode hadn’t aired at time of writing).

The conclusions may be unsurprising, but the journey was worth it.

• Findout more about the BBC’s Headroom campaign:

• To see what others are saying go to CareSpace

• Expert information on mental health

This article appeared in the 20 November issue under the headline “Shrink-wrapped entertainment”

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