An independent review has challenged claims that young people are being broadly overdiagnosed with mental health conditions. The Fonagy Review finds that mental distress has risen substantially and calls for people to be able to access support before they receive a clinical diagnosis.
The review, chaired by British psychoanalyst and clinical psychologist Professor Peter Fonagy, says the rise in ADHD and autism diagnoses needs careful consideration. However, it found that the population-level prevalence of the two neurodevelopmental conditions appears broadly stable.
Speaking to BBC Radio 4’s Today programme, Fonagy said former health secretary Wes Streeting was “with respect, completely wrong” to suggest there was an overdiagnosis of mental health disorders. The review found that distress among young people had increased, with anxiety and depression contributing to the rise.
It identifies several possible factors, including social media, financial insecurity, uncertainty about the future, poorer sleep and reduced feelings of connection and belonging. The report also warns that diagnosis has increasingly become a narrow route through which people seek support for complex needs.
“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,” Fonagy said.
Government promises earlier support
The Government says its forthcoming Mental Health Strategy will focus on prevention and early intervention, with support available in schools, colleges and communities without people having to wait for a clinical diagnosis.
Health and Social Care Secretary Yvette Cooper said the review showed the importance of earlier help for mental health and neurodevelopmental conditions.
“It is clear 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,” she said.
The Government has asked NHS leaders to examine how people can access advice, assessment and treatment more easily. Its announced measures include expanding Mental Health Support Teams to every school and college by 2029, reaching nearly 800,000 additional children and young people this year, and investing £7 million in Early Support Hubs in 2026/27.
It also plans to extend support in the early years and invest in specialists who can work with children in mainstream schools, early years settings and colleges. These measures will sit alongside a £4 billion package for children with special educational needs, which the Government says will improve inclusion, widen access to specialist support and provide training for teachers.
Tighter oversight of ADHD and autism assessments
Alongside earlier support, the Government plans to strengthen oversight of ADHD and autism assessments. It is working towards making all diagnostic assessments a Care Quality Commission-regulated activity, covering NHS-funded, private and self-funded assessments.
The review raised concerns about the consistency and quality of assessments, particularly where services are provided independently. Fonagy said national standards were needed, while recognising that some independent providers deliver excellent services.
The Government will ask the Advertising Standards Authority to consider advertising for ADHD and autism services. NHS England plans to consult on a national tariff for NHS-funded services, covering assessment, post-diagnostic support and follow-ups, with new payment arrangements intended from April 2027. The Government will also work with the National Institute for Health and Care Excellence (NICE) to consider the implications of the review for clinical guidance.
Cooper said regulation should help ensure assessments are high quality and that the NHS is not overcharged by independent or private providers.
Fonagy Review suggests support should reflect needs, not labels
The review warns that a diagnosis can sometimes become a label that overshadows a person’s strengths and potential, affecting their experience in education, work and relationships. It calls for better support after diagnosis and for schools, workplaces and public services to respond to people’s needs.
Mental health organisations broadly welcomed the review’s focus on earlier help. Andy Bell, chief executive of the Centre for Mental Health, said:
“More people, and young people especially, are experiencing mental distress and ill health.”
He said the Government’s new strategy was an opportunity to put the recommendations into practice, adding that local government, the NHS, businesses and civil society all had a role in improving mental health.
The Royal College of Psychiatrists also welcomed the emphasis on support before diagnosis, while warning that long waits for assessment and specialist treatment must be addressed. Its president, Professor Subodh Dave, said:
“Those showing initial signs of distress shouldn’t need a diagnosis to access basic levels of support at school, work or within their communities.”
The review highlights the links between health, education and employment. It notes that mental health or autism is a factor for many young people who are not in education, employment or training. Fonagy argues that success should be measured by people’s wellbeing and ability to participate in their communities, education and work—not simply by whether they receive a diagnosis.
The test will be delivery
The review sets out a shift towards support that is earlier, more flexible and based on need, while retaining timely diagnosis and treatment for people who need them. The Government has announced a range of measures, but its full response will be set out in the Mental Health Strategy later this year.
The test will be whether these commitments translate into accessible help in schools and communities, shorter waits for assessment and treatment, and properly supported specialist services. Earlier help should widen the route into care; it must also be matched by the capacity and expertise to support people with complex or severe needs.
The review and the Government’s announced reforms apply to England.
To find out more about UK Healthcare and Life Sciences Innovation (UKHLSI) Mental Health Working Group, please contact enquiries@ukhlsi.co.uk