Fonagy review calls for mental-health support before diagnosis

• The review says mental distress has risen substantially in England, especially among young people.
• More than 560,000 people were waiting for an ADHD assessment and 254,000 for an autism assessment at the end of 2025, according to figures reported from the review.
• Its central proposal is to offer help before diagnosis and prioritise specialist assessments by need.
• The authors warn of growing risks of misdiagnosis and overdiagnosis, but say they cannot conclude that overdiagnosis is already happening at scale.

England’s mental-health and neurodevelopmental services risk being overwhelmed by rising demand and long waits, a government-commissioned review led by Professor Peter Fonagy says. Presented on Friday, 9 October, it calls for a shift away from making diagnosis the main gateway to support. ¹²

The review says the share of people aged 16 to 64 with a common mental disorder rose from 15.5% in 1993 to 22.6% in 2024. The rise was steeper among 16- to 24-year-olds, reaching about one in four. The report says the increase is real and cannot be explained by greater awareness alone. ¹

At the end of 2025, more than 560,000 people in England were waiting for an ADHD assessment and another 254,000 for an autism assessment, the Guardian reported from the review. These are waiting-list figures, not estimates of how many people have either condition. ¹

The proposed change is to provide practical help when people need it, rather than leaving them without support until they receive a diagnosis. The review also recommends reviewing waiting lists so people with the highest needs can reach specialist assessment sooner. ²

That approach carries a difficult trade-off. The review warns that rising diagnoses create greater risks of misdiagnosis and overdiagnosis, but says the evidence does not establish that overdiagnosis is already occurring at scale. Diagnosis remains important, while a label alone should not decide whether someone can get help. ¹²

The government collection page for the review listed its interim report and terms of reference on Friday, not the final document. The final findings described here were reported by the Guardian and the Independent after the report was presented to journalists, an event confirmed by the Science Media Centre. ³⁴

Health Secretary Yvette Cooper said the government would draw on the review in its forthcoming mental-health strategy, according to the Guardian. The paper also reported that she backed regulating assessment clinics but did not commit to the review’s proposed ban on advertising assessments directly to the public. ¹

The Independent reported concern from Bournemouth University psychologist Rachel Moseley that prioritising the most acute cases could leave some autistic and ADHD people with substantial but less visible needs without diagnosis or support. Nuffield Trust chief executive Thea Stein said a needs-led model would depend on support actually being available and funded. ⁵

Footnotes

1. The Guardian, “NHS at risk of ‘system failures’ as demand for ADHD and autism care soars, inquiry finds” ↩ ↩² ↩³ ↩⁴ ↩⁵

2. The Guardian, “NHS England mental health services review: what has it found and what does it recommend?” ↩ ↩² ↩³

3. Department of Health and Social Care, review collection ↩

4. Science Media Centre, final report and recommendations briefing ↩

5. The Independent, “Not everyone with ADHD and autism traits needs a diagnosis, major review finds” ↩