An independent review into mental health, ADHD and autism in England has sharpened a debate about how young people access support—and whether diagnosis is being blamed for problems that services have not been equipped to manage.
The review, published the previous Friday, found that mental distress across the population has substantially worsened, particularly among young people. It also examined the need for support linked to neurodevelopmental differences.
Prof Peter Fonagy told the BBC that former health secretary Wes Streeting was “completely wrong” to suggest that conditions and disorders were being overdiagnosed. Streeting later acknowledged his mistake.
A debate about distress and diagnosis
Some rightwing politicians and commentators have argued that the medicalisation of ordinary states of mind is driving the increase in young people seeking help. The review’s conclusions, as described in the editorial, point instead to real increases in psychological distress and a genuine need for support.
That does not mean every question about assessment is settled. Ministers have accepted a proposal for stronger regulation of ADHD and autism assessments. Many assessments are currently delivered by private providers in a market with low barriers to entry and no common standards.
Long NHS waiting lists have also driven demand for private assessment services. In this setting, diagnosis can become more than a description of someone’s difficulties: it can act as a gateway to help.
When diagnosis becomes a route to care
The experts cited in the editorial argue that access to services should be based on need rather than labels. At present, however, diagnosis has become a “door to support” in mental health and special educational needs settings.
When demand overwhelms services, diagnosis-based thresholds can function as a form of triage. This can leave people waiting for support while they try to obtain the label that may unlock it.
The scale of unmet need is also difficult to see in official figures. Years-long queues for mental health care and neurodevelopmental support are not included in official waiting-list figures, according to the editorial.
Parity of esteem remains unfinished
The principle of “parity of esteem”—the idea that people with mental ill health should have equivalent entitlements to people with physical illnesses—has been prominent for 15 years. The editorial argues that it has not been fully realised.
Services are described as inadequate for the demand placed on them. The review recommends stronger accountability for mental health within the Department of Health and Social Care and suggests that its proposals should be incorporated into the upcoming mental health strategy.
It also argues for a 10-year plan that would bring mental health and neurodevelopmental support together in one service. The editorial says broader reform cannot be achieved without new funds, although the review does not specify how much additional funding would be needed.
What happens next
The government’s fiscal rules will affect decisions about how these problems are addressed. The review repeatedly refers to the need for investment, but it does not explicitly call for mental health budgets to rise as a proportion of overall health spending. Nor does it make the case for waiting-list targets.
Those omissions matter because the central challenge is not simply how conditions are named or assessed. It is whether people can obtain timely, appropriate support when they need it.
Yvette Cooper has followed her predecessor as health secretary in saying relatively little about mental health and young people. The editorial calls on her to show that she is listening as the government considers its mental health strategy.
AI tools were used to assist with the preparation of this article.
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