The Assurance Reflex: When Good Intentions Lead Us Astray

In recent years, the UK has seen a significant rise in mental health diagnoses and psychiatric medication prescriptions. According to NHS data, the number of people prescribed antidepressants in England rose from 6.7 million in 2017–2018 to 8.6 million in 2022–2023 (NHS Business Services Authority, 2023). Diagnoses of ADHD in both children and adults have surged, with some regions reporting increases of over 20% in just two years (Newlove-Delgado et al., 2022). While these figures reflect increasing awareness and willingness to seek help, they also raise important questions about how we, as professionals and supporters, respond to distress—and whether we are too quick to pathologise normal human experiences.

We all want to help. Whether you’re a GP, a mental health professional, a teacher, a friend, or a family member—when someone is struggling, the instinct to do something, to offer something, kicks in. That instinct is human, compassionate, and well-meaning. But sometimes, it can unintentionally lead us down the wrong path.

I am going to call this instinct the Assurance Reflex.

What is the Assurance Reflex?

The Assurance Reflex is the strong tendency for professionals and helpers—whether in healthcare, education, or day-to-day life—to offer something concrete when faced with another person’s emotional distress, complexity, or ambiguity. We do this naturally. It comes from a place of goodwill and a sense of duty—a need to provide something tangible that brings a sense of certainty to both ourselves and the person in front of us.

When we’re presented with someone who is struggling, we instinctively want to reduce both their discomfort and our own. Offering something—whether it’s a service, a referral, medication, or even advice—feels more helpful than offering nothing. It gives both the helper and the person being helped a sense of direction and closure. But often, the most helpful options are the least tangible: validation, encouragement to make a lifestyle change, or simply holding space. These responses can feel too subtle, too slow, or too easily misunderstood.

It is often easier to suggest a medical solution or signpost to a mental health service than to say, “I don’t think this is a mental health problem” or “What you’re experiencing makes sense given everything going on in your life.” Even suggesting a walk, better sleep, or reconnecting with a friend can feel underwhelming, despite being deeply effective. The Assurance Reflex means we are more likely to offer something that gives us and the other person a sense of certainty—even when that ‘something’ might not be what’s most needed.

In healthcare, it might look like a GP offering antidepressants to someone presenting with stressors that are more situational than clinical. Or a mental health practitioner adding someone to a counselling waitlist when the real need is for social connection, financial support, or parenting help. For friends or family, it might mean nudging someone to see a GP when what they really need is someone to listen or walk alongside them.

Why Do We Do It?

There’s a deeper layer to the Assurance Reflex that’s important to understand. When we have something we can offer—something that provides a clear action or outcome—it’s far easier and more natural than having a more honest or uncertain conversation. Certainty feels like compassion. Certainty feels like care.

Take the example of a GP in a 10-minute appointment. A patient opens up about an array of complex life stressors: money worries, a relationship breakdown, job insecurity, and sleep difficulties. The GP is faced with a choice. They could say, “I’m sorry—what you’re experiencing makes sense in the context of everything you’ve mentioned. I don’t think this is a mental health problem. What you need is rest, community support, and to prioritise some of your basic needs.” But that’s hard. It might feel dismissive. The GP risks the patient feeling invalidated or unsatisfied.

So instead, the GP provides them with a sense of direction—a referral, a prescription, a next step. Something. That’s the Assurance Reflex at work. For the record, I’m not picking on GPs. There is a huge amount of excellent practice out there. But GPs are often the most visible and relatable example to illustrate the Assurance Reflex.

The same applies in mental health services. A professional may see someone with a wide range of social and emotional stressors—none of which indicate a clinical condition or even suitability for specific interventions. Yet rather than risk seeming like they’re offering “nothing,” they refer the person for counselling or therapy. Not because it’s the most fitting intervention, but because it feels like doing something.

Because doing something feels better than doing nothing. It soothes our own discomfort with ambiguity. It gives us a sense of control and usefulness. It’s also easier.

I’m not a psychologist, but there are some other terms that the Assurance Reflex echoes:

• Action Bias: the tendency to favour action over inaction, even if the action isn’t necessarily helpful.

• Ambiguity Aversion: our discomfort with uncertainty prompts us to make premature decisions.

• Moral Distress: the tension we feel when we can’t offer what we know might be more helpful due to service limitations.

When the Reflex Goes Wrong

At its worst, the Assurance Reflex leads to:

• Overt diagnostic overshadowing – validating someone’s difficulties solely through the lens of illness or pathology often results in an implied or actual diagnosis. Once a diagnosis is made, it implies that a medical intervention is required. This reduces the likelihood of the person’s broader social and wellbeing needs being acknowledged and addressed in meaningful ways.

• Over-pathologising normal emotional responses. It’s no secret that mental health diagnoses are increasing and that mental health disorders have become part of everyday language and identity.

• Over-diagnosing and labelling people too quickly. For example, a person who is grieving may be given a diagnosis of depression instead of being supported to process a healthy emotional reaction to loss. Or some spinning a few too many plates are a burnt out, being advised to get therapy, when they need a break.

• Over-reliance on services that may not be appropriate. This can overwhelm services, making it harder for people with significant mental health needs to get timely care. For example, someone with serious anxiety disorder may be delayed in accessing support because the waiting list is filled with people whose needs could have been met through community or practical interventions.

All this focus on illness and mental health can lead to situations where someone begins to see themselves as the diagnosis, their identity shifts, their narrative changes. They’re no longer a person going through a tough season of life—they may become a “mentally ill person.” And that shift can be incredibly limiting, even if the person subjectively feels this is of benefit. It’s hard. Someone told they have ‘biological depression’ may begin to limit themselves—believing they can’t do certain things because they are depressed.  Alternatively, imagine the same person, but instead they were told they are experiencing transient depressive symptoms. A temporary set of symptoms that they could likely overcome. They can move forward more freely, without that diagnosis dragging them down.

Meanwhile, the actual solutions—the ones that are grounded in lifestyle and human connection—get lost. Exercise, sleep, good food, community, purpose. These powerful interventions get sidelined because they seem too basic or too slow compared to a referral or a prescription.

Why It Matters

When we default to the Assurance Reflex, we risk:

• Missing the real story.

• Undermining the person’s resilience.

• Making mental health systems more congested with people who need practical or social support, not medical intervention.

Sometimes the bravest and most effective thing a professional can do is not make a referral. Sometimes the best help a friend can give is to go for a walk with them, or invite them out, giving them a little push, not push for therapy. It’s about seeing the whole person, zooming out, and asking, “What’s really going on here?” Not just, “What can I do right now?”

I’m absolutely not saying that everyone with mental health concerns doesn’t need medication or therapy. Not at all. If you’ve read my other blogs, you’ll know that one of my core messages is about ensuring the right people get the right help.

So What Can We Do Instead?

1. Pause before acting. Ask yourself, “What am I trying to relieve—their distress or my discomfort?”

2. Explore context. Life stressors, loneliness, fatigue, and burnout can all mimic mental health symptoms. Don’t succumb to overt diagnostic overshadowing. Many stressors—or even physical problems—can affect mental health, but that doesn’t mean they are mental health disorders.

3. Empower simple steps. Don’t underestimate the impact of suggesting a daily walk, sleep hygiene, or joining a local group.

4. Normalize being human. Not every rough patch is a disorder. Sometimes—actually, often—life is just hard.

In Summary

The Assurance Reflex is a natural, compassionate instinct. But left unchecked, it can feed a culture of over-diagnosis, disempower people, and crowd out the very things that actually support wellbeing. Naming it allows us to challenge it. It gives us permission to be slower, more curious, and more holistic in how we support others.

Let’s honour the instinct to care—but also the wisdom to sometimes wait, listen,  do less and do what is needed. 

References

NHS Business Services Authority. (2023). Prescription cost analysis – England 2022/23. https://www.nhsbsa.nhs.uk

Newlove-Delgado, T., Blake, S., Ford, T., Janssens, A., & Edwards, V. (2022). Young people with ADHD in the UK: Prevalence, characteristics, and service access. BMJ Open, 12(6), e059931. https://doi.org/10.1136/bmjopen-2021-059931