A government-commissioned review has warned that the NHS in England is moving towards a “world of system failures” as demand for mental health, ADHD and autism services increases.
Led by Prof Peter Fonagy, the 10-month review recommends changing how support is provided. Its central proposal is that access to care should depend primarily on a person’s needs, rather than on whether they have received a formal diagnosis.
Long waits are driving pressure on services
At the end of last year, more than 560,000 people in England were waiting for an ADHD assessment—17 times the number recorded in 2019. A further 254,000 people were waiting for an autism diagnostic assessment.
Together, the figures represent more than 800,000 people waiting for an ADHD or autism assessment. Almost 90% had been waiting for at least three months.
The review argues that a needs-led approach could help people receive support during these waits, rather than making access to help dependent on completing an assessment first.
Demand and diagnoses have risen sharply
The proportion of 16- to 64-year-olds in England with a common mental disorder rose from 15.5% in 1993 to 22.6% in 2024. Among 16- to 24-year-olds, the proportion increased from about one in six to one in four.
The review said the increase in young people’s mental health problems is real, affects everyday functioning and cannot be explained by greater awareness alone.
It also reported substantial increases in recorded autism and ADHD diagnoses among children. Between 2000 and 2025, the proportion of six- to 11-year-olds diagnosed with autism rose 20-fold to 4.58%. Among 12- to 17-year-olds, it rose from 0.1% to 4.06%.
ADHD diagnoses also increased. Over five years, the proportion of six- to 11-year-olds with a diagnosis rose more than sixfold, reaching 2.7%, while the proportion among 12- to 17-year-olds rose more than 15-fold, reaching 3.9%.
Review highlights risk without claiming widespread overdiagnosis
The review identified an increasing risk of overdiagnosis and misdiagnosis, but its authors did not conclude that overdiagnosis was occurring at scale. Instead, they said the risks were becoming increasingly important for policy and service delivery.
Prof Simon Wessely said the rise in autism and ADHD diagnoses had brought the UK to a “tipping point” at which people could be at risk of being misdiagnosed.
The review also found strong concerns about the consistency and quality of assessments carried out by independent providers, including the financial incentives linked to assessment activity. It said as many as one-fifth of secondary school pupils identify as neurodivergent.
Calls for tighter regulation of private clinics
The review recommends that every clinic providing ADHD or autism assessments be regulated by the Care Quality Commission. It also calls for a ban on direct-to-public advertising for these services.
Health secretary Yvette Cooper said the government would ensure that private assessment clinics are regulated. She did not commit to the proposed advertising ban.
Cooper said the government would use the review’s recommendations in its mental health strategy, due by the end of the year. She also asked NHS England to establish how it could provide faster advice, assessments and treatment.
Why joined-up support matters
The review said co-occurring mental ill-health and ADHD or autism was “the rule rather than the exception”. Among 16- to 24-year-olds with a common mental health condition, 61% also had autistic traits and 57% had ADHD symptoms, according to the report.
It recommends bringing mental health and neurodevelopmental services together. The Royal College of Paediatrics and Child Health supported the idea that diagnosis should no longer determine who receives care.
The review also projected that 4 million children currently experiencing “high psychological distress” could increase to 4.5 million by 2030 if current trends continue. It said the number of under-18s who self-harm could rise from 1.9 million to 2.5 million under the same assumption.
These projections describe possible outcomes rather than certain forecasts. The broader message of the review is that services may need to respond earlier and more flexibly, while improving the reliability and oversight of assessments.
AI tools were used to assist with the preparation of this article.
Leave a Reply