In a personal reflection on his time as a consultant occupational psychiatrist to the Metropolitan Police Service, Doctor Derek Summerfield comments on his views of the grounds for early retirement on mental health grounds of some 300 officers. 1 He finds a change of culture throughout our workforce from the facing of stresses with resilience to the acceptance of vulnerability. Incapacity payments for ill-defined mental health issues, and the prescription of antidepressants, have escalated to an alarming extent since the 1990s. A similar culture change is occurring in paediatrics, where a child may no longer be diagnosed as stupid or badly behaved, but must be given a socially acceptable diagnosis such as dyslexia, or attention deficit hyperactivity disorder, ADHD. Such dubious disorders are frequently heard in the charge rooms of our police stations. Police officers have developed a culture in which retirement planning and pension entitlement are important. An officer is awarded a pension after 30 years’ service or if they retire on grounds of ill health. It is said that officers are very seldom sacked for inefficiency or other work problems, but are given ill health retirement instead. This has left a culture of entitlement to ill health retirement, and to regarding the occupational health service as a barrier to this entitlement. Dr Summerfield argues that: † Certification on mental health grounds is the leading cause of sickness absence, yet it is largely patient-led; † The medicalisation of non-specific symptoms may promote secondary handicap and prolong disability;