A major UK review of mental-health conditions, ADHD and autism has urged a more careful approach to diagnosis—and a broader approach to support.
The review says that, if current trends continue, the risks could shift from people being missed or diagnosed too late towards increased misdiagnosis and overdiagnosis, particularly for autism and ADHD. But it also makes clear that the evidence is not strong enough to conclude that overdiagnosis is currently happening at scale.
What the review does—and does not—say
The 600-page report was commissioned in late 2025 by then health secretary Wes Streeting and co-authored by Peter Fonagy, Gillian Baird and Simon Wessely.
Its authors say that much of the data needed to resolve the debate simply does not exist. They also reject the assumption that people seeking help today are generally less impaired than those who sought help in the past: “the evidence does not show that people presenting today are less impaired than those presenting previously”.
Fonagy later said on Radio 4’s Today programme that Streeting had been “completely wrong” to agree with suggestions that common overdiagnosis of mental-health disorders was taking place.
The distinction matters. The review identifies possible future risks without presenting a settled finding that current diagnoses are broadly invalid or unnecessary.
From diagnosis-first to needs-led support
One of the report’s central proposals is “a fundamental shift from a diagnosis-dependent system to a needs-led plus diagnosis system”. Under that approach, access to help would not depend entirely on receiving a particular label, while diagnosis would continue to have a role.
The report links that change to increased capacity, digitally enabled care, clearer national standards and sustained investment. In other words, changing the principle of access would not by itself create more appointments, assessments or treatment.
The review also defines neurodiversity as the idea that variation in brain function, cognition and behaviour is part of natural human diversity rather than pathology or disorder. That framing sits alongside its warning that some people may still need assessment and support.
Private clinics and public responsibility
The review proposes closer regulation of private diagnostic clinics, which are often partly NHS-funded, and recommends stopping them from advertising their services.
The government’s response said that health and social care secretary Yvette Cooper had asked NHS leaders to urgently examine how people could access advice, assessments and treatment more easily.
That response does not settle the funding question. Reports cited in the article said that the prime minister and chancellor had rebuffed Cooper’s requests for money to fund a pay rise for NHS staff, including nurses, porters and midwives. Without sufficient resources, a needs-based system could remain an aspiration rather than a practical alternative.
Why implementation will matter
The wider concern is that responsibility for support may be spread across systems that already struggle to meet demand. The article describes a culture in the Department for Work and Pensions centred on crackdowns and pushing people into work, and says councils repeatedly fail to meet responsibilities for the care and education of neurodivergent people.
Those claims point to a question beyond the accuracy of diagnostic trends: what happens to people who need help but cannot secure a label, an assessment or a service?
The review offers a possible direction—better standards, more accessible support and greater scrutiny of private provision. Its success would depend on whether those changes receive the capacity and sustained investment the report says they require.
The practical takeaway
For now, the review supports caution rather than a simple verdict in the overdiagnosis debate. It does not establish that overdiagnosis is occurring at scale, nor does it suggest that people seeking assessment today are less impaired as a group.
Its more significant proposal may be to separate access to useful support from diagnosis alone. That shift could help people whose needs are real but whose route through assessment is uncertain—provided the services, staff and public funding exist to make it real.
AI tools were used to assist with the preparation of this article.
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