A review of mental-health conditions, autism and ADHD in England has rejected the idea that rising levels of distress among young people can be explained simply by widespread overdiagnosis.
Prof Peter Fonagy’s review says the increase in conditions such as anxiety and depression is real, as are the distress and difficulties they can cause. It attributes the rise largely to cultural and social factors, including disruption caused by Covid, financial and housing insecurity, and intense competition at school and in social life.
Those pressures have also been exacerbated by social media, the review says. At the same time, it points to the loss of community supports such as Sure Start and youth clubs, alongside less belonging and more loneliness.
A challenge bigger than individual resilience
Fonagy writes that he was a severely depressed teenager in 1960s London. His conclusion is that young people today are not fragile, but “outnumbered” by the pressures around them. He also cautions that “simple answers are rarely adequate”.
That framing matters because it places mental health in a wider social context. The review does not describe distress as a personal failing, nor does it suggest that every difficulty should automatically result in a diagnosis. Instead, it presents a combination of genuine need, difficult circumstances and systems that are struggling to respond.
Why diagnosis has become so important
The review acknowledges a risk of overdiagnosis, but says there is no evidence that it is happening at scale. It is critical, however, of the growth and reliability of unregulated private diagnostic providers.
Fonagy identifies a deeper problem: diagnosis has become disproportionately important for accessing clinical care, special educational needs support in schools and disability benefits. When support depends heavily on a diagnostic label, people who can afford a private assessment may have a better chance of receiving help.
NHS diagnosis waiting times are stated in the review as 64 weeks. That delay can make a diagnosis feel like the gateway to support, even when a person’s needs are already clear.
A needs-led alternative
Fonagy proposes reducing reliance on diagnosis and identifying and triaging people’s needs earlier, so they can receive appropriate support more swiftly. The review’s approach would place the focus on what help an individual requires, rather than treating a label as the only route to assistance.
That proposal is not guaranteed to be accepted or implemented. The review also warns that rising prevalence across mental illness, ADHD and autism has wider consequences, including overwhelmed public services, people being unable to obtain care or support, and costs to taxpayers that are not sustainable.
Part of a wider policy debate
The issues identified by Fonagy are also being considered through the imminent Milburn review of the youth jobs crisis, the Timms review of disability benefits and the government’s planned changes to SEND.
Streeting commissioned Fonagy’s review nine months ago. The health secretary had said 18 months earlier, during a discussion about disability benefit cuts, that mental-health conditions were being “overdiagnosed”; he later apologised for the comment.
Fonagy’s central warning is clear: continuing with the current approach is not sustainable. His review argues that responding fairly will require both recognition of genuine distress and a support system that does not make diagnosis the only practical route to help.
AI tools were used to assist with the preparation of this article.
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