Fonagy review: ADHD and autism help should not wait for a diagnosis
The Fonagy review finds demand for assessment soaring while true prevalence holds steady, and asks the NHS to stop making a diagnosis the price of support.
By
Katharina Brenner
England’s independent review of mental health, ADHD and autism concludes that the two neurodevelopmental conditions face a rising risk of overdiagnosis, yet it stops short of saying overdiagnosis is already widespread. Its answer is structural rather than clinical: help should follow a person’s needs, with a diagnosis remaining available but no longer acting as the only key to support in health care, schools, welfare and work.
In brief
- Its answer is structural rather than clinical: help should follow a person’s needs, with a diagnosis remaining available but no longer acting as the only key to support in health care, schools, welfare and work.
- Here it rejects any notion of overdiagnosis: genuine illness has grown, driven by anxiety, depression, self-harm and eating disorders, while severe conditions such as schizophrenia and bipolar disorder have not increased.
- NHS England’s director for mental health, Dr Nick Broughton, said: “The NHS is ready to play its part.”
The review was chaired by Professor Peter Fonagy, with Sir Simon Wessely and Gillian Baird as vice-chairs. It was appointed in December 2025 and published on 9 October, and its conclusions bear on decisions well beyond the clinic.
Two kinds of prevalence, and a gap between them
The central distinction in the report is between population prevalence, meaning how many people actually have a condition, and administrative prevalence, meaning how many come forward to services. According to the Manchester Evening News, the review found the first has stayed broadly stable while the second has risen steeply. Its best estimates put ADHD at 3.8% of children aged 5 to 15 and autism at 1.2% of those aged 5 to 19.
Recorded diagnoses tell a different story. Research behind the review puts diagnosed autism among boys aged six to 11 at 0.4% in 2000 and 6.3% in 2025. That is the kind of divergence that led the authors to speak of an increasing risk. Wessely framed the moment this way: “We are moving away from a period of underdiagnosis into a kind of tipping point in which other things might be happening as well.”
The evidence has limits the review itself acknowledges. Surveys measuring the true level of autism have not been carried out for nine years, so the team could not conclude that overdiagnosis is occurring “at scale”.
Demand, waits and a real rise in distress
Whatever the debate over neurodevelopmental labels, pressure on services is not in dispute.
The review draws a sharp line between ADHD and autism on one side and mental illness on the other. Here it rejects any notion of overdiagnosis: genuine illness has grown, driven by anxiety, depression, self-harm and eating disorders, while severe conditions such as schizophrenia and bipolar disorder have not increased.
| Indicator | Finding |
|---|---|
| People waiting for ADHD or autism checks | 900,000, of whom 90% have waited more than three months |
| Young people referred to mental health services | A third wait more than a year |
| Mental illness among 16 to 24-year-olds | Up from about one in six to one in four |
| Yearly price tag of mental ill health in England | About £300bn, of which £110bn is borne by the economy and £60bn by the NHS |
| Local example, West Yorkshire: routine assessments by independent NHS providers | Minimum two-year wait, urgent cases possibly sooner |
Support that no longer waits for a label
The core recommendation, as reported by the Mirror, is a move from a diagnosis-dependent system to a needs-led one. People on waiting lists would be actively reviewed so that those with higher needs are assessed sooner, while those with moderate needs receive help in the meantime. Fonagy put the principle plainly: “Diagnosis remains essential and must be protected, what has to change is that it is no longer the only door through which help can be reached.”
A diagnosis does not currently guarantee much afterwards. Among clinicians surveyed for evidence the review considered, 40% said no ongoing autism support followed diagnosis, and only 12.6% described anything beyond a single session, figures reported by loveballymena.online. Baird argued that “diagnosis doesn’t tell you very much about a person’s needs and what level of support they require. You need more than a diagnosis.”
Private and other non-NHS providers now perform roughly half of NHS-funded ADHD assessments and a third of autism ones. The review questioned their quality and consistency and noted that the cost of private ADHD provision rose by about 252% in three years. The Government has said it will bring these providers under Care Quality Commission regulation and is looking again at how they advertise; the authors would go further and stop assessments being marketed straight to the public.
Welfare, schools, work and a political dispute
The stakes extend into the labour market. About a third of young people aged 16 to 24 who are outside education, work and training say their mental health or autism plays a part, and young people diagnosed with ADHD before turning 17 are four times as likely as peers without the diagnosis to be in that group. Health Secretary Yvette Cooper responded that “mental health services need to change to focus more on the early support young people need to stay in education or work or keep their lives on track.”
The commissioning itself was contested. Wes Streeting, health secretary at the time, commissioned the review having voiced concern about over-diagnosis among the young; Fonagy has since called that view “completely wrong” where mental health is concerned. The BBC notes the findings could reshape NHS services, benefits, schools and employment support.
- Fonagy appointed to lead the review.
- Report published.
- Government response expected in a new Mental Health Strategy.
- Period over which the review wants action.
NHS England’s director for mental health, Dr Nick Broughton, said: “The NHS is ready to play its part.”
Featured image. Source: Pexels. Credit: Cedric Fauntleroy. License: Pexels License.
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