An independent review of mental health, autism and ADHD in England, led by Prof Peter Fonagy, was published on Friday. The 607-page report warns that the NHS in England is heading towards a "world of systemic failures" and that "continuing as at present is not sustainable".
The review was commissioned in 2025 by the then health secretary Wes Streeting. The report states that mental suffering has "increased significantly in the population", is real and affects daily functioning, and the rise "cannot be explained solely by greater awareness". Around one in four people aged 16 to 24 now have a common mental disorder such as anxiety and depression, compared to one in six in 1993. The proportion of people aged 16 to 64 with common mental disorders rose from 15.5 per cent in 1993 to 22.6 per cent in 2024. Around 4 million children are in "serious suffering", and if trends continue, this number could reach 4.5 million by 2030. At current rates, cases of self-harm could reach 2.5 million. Rates of severe mental illnesses such as bipolar disorder or schizophrenia have remained much more stable, and risky drinking is in decline. The cost of poor mental health is £300 billion a year.
The report notes that the proportion of the population considered to have ADHD is stable at an estimated 3.8 per cent, and autism at 1.2 per cent. However, the proportion of children aged six to 11 with an ADHD diagnosis has risen more than sixfold in five years, to 2.7 per cent, while among those aged 12 to 17 it has risen more than 15-fold, to 3.9 per cent. The number of children aged six to 11 with an autism diagnosis rose 20-fold to 4.58 per cent between 2000 and 2025, and among those aged 12 to 17 from 0.1 to 4.06 per cent, a 40-fold jump. More than 560,000 people are waiting for an ADHD assessment, and more than 254,000 for an autism assessment, totalling more than 800,000. Nearly 90 per cent are waiting at least three months, and NHS waiting times for diagnosis amount to 64 weeks. Prof Simon Wessely, deputy chair of the review, said we have reached a tipping point where there is a risk that people will be misdiagnosed with ADHD and autism. The report notes that "this in itself does not establish that overdiagnosis is currently occurring on a large scale".
The report is sharply critical of the growth and reliability of unregulated private diagnostic assessment providers. NHS spending on ADHD services in the independent sector rose by 252 per cent in three years, and private providers accounted for more than a third of NHS-funded autism assessments in the financial year 2025-26. Health secretary Yvette Cooper said the government would "make all diagnostic assessments for ADHD and autism regulated by the Care Quality Commission", and the Advertising Standards Authority will be asked to review private sector advertising for ADHD and autism assessments. The report claims that a deeper problem is the disproportionate power of diagnosis in accessing clinical care, support for special educational needs in schools or disability benefits, and that those who can afford a private diagnosis have a greater chance of receiving support.
Fonagy, a psychoanalyst and clinical psychologist at University College London, said the NHS should shift from a diagnostic labelling model to a flexible needs-based system. "Diagnosis remains key and must be protected," he said, but "what must change is that it is no longer the only door through which help can be accessed". The report notes that individual needs should be identified and triaged early with the aim of quickly receiving the necessary support. Fonagy was a severely depressed teenager in London in the 1960s, and wrote: "I am in awe of their courage. Young people are dealing with more powerful forces than I ever faced. They are not fragile. They are overwhelmed."
The report states that the drivers of the rise in mental health problems are cultural and social. Young people are exposed to Covid-related disorders, financial and housing insecurity, and stresses from competitive schools and society exacerbated by social media. Support services, from Sure Start to youth clubs, have been removed, there is less belonging and more loneliness. The number of young people in the UK not in education, employment or training is now nearly 1 million, and a record 2.8 million people are too ill to work. Fonagy said there is increased insecurity – financial pressures, insecure work, inaccessible housing – but perhaps more importantly, a lack of hope among young people that their lives will be better than those of their parents. This, he added, is the first time since the Second World War that surveys have noted this. The report notes that public debate has focused on whether there are too many or too few diagnoses, that public services are overstretched, people are suffering because they cannot access care or support, and the cost to taxpayers is unsustainable, and that the answer to whether diagnosis is excessive or insufficient is frustrating.
