Mental Health Review Warns of Failing System and Overdiagnosis Risk

A major review has concluded England's mental health and neurodevelopmental assessment system is failing, with people waiting years for help and support fragmented across services. Health leaders have been instructed to urgently examine how people can access advice, assessments and treatment more easily, with a particular focus on removing barriers to support. The audit, chaired by Professor Peter Fonagy, found the current system 'falls short', with help 'locked behind waiting for a diagnosis'. It calls for a shift away from this diagnosis-dependent model, which is needed to access education support and some benefits, deeming the current waits unsustainable.

Growing demand and long waits

Soaring numbers of young people are waiting for ADHD and autism assessments. At the end of 2025, there were more than 560,000 people in England waiting to be assessed for ADHD and 254,000 waiting for an autism assessment. Of the 900,000 people waiting for ADHD or autism checks, 90% have waited more than three months. A third of young people referred to mental health services wait more than a year for assessment.

This demand has profound impacts. Around a third of 16 to 24-year-olds not in education, employment or training report their mental health or autism as a factor. Those diagnosed with ADHD before the age of 17 are four times more likely to be in this group than those without.

Concerns over diagnosis and support

Experts warn of risks from both over- and under-diagnosis. The review authors said they cannot conclude that overdiagnosis is occurring at scale, but warned of an increased risk of misdiagnosis and overdiagnosis. They noted a rise in diagnoses over 25 years means cases now appear to outstrip the expected number in the population for some younger age groups. Having ADHD- or autism-related traits does not necessarily mean someone has a diagnosable condition.

Inaccurate labels can do harm by directing someone towards the wrong treatment. The review gave an example of a student experiencing marked loneliness but not major depression being prescribed antidepressants when better options exist. Overdiagnosis can lead to over-medicalisation when other support might be more suitable. Professor Peter Fonagy, the chair, disputed claims of widespread overdiagnosis, stating that Wes Streeting was 'completely wrong' on that.

Dr Rachel Moseley, principal academic in psychology at Bournemouth University, cautioned against prioritising only the most severe needs. She warned of a threat that diagnosis and support will be rationed to the detriment of groups whose differences are less extreme but who still suffer.

Responses and recommendations

The review calls for action within 12 to 24 months. Key recommendations include ending diagnosis-dependent access to help, regulating private providers, and banning direct-to-public advertising of assessments. It raised concerns about the consistency and quality of private providers, which conduct more than half of NHS-funded ADHD and a third of autism assessments. The cost of a private ADHD diagnosis has soared by 252 percent in three years.

The government has promised to act and is expected to set out more details in its forthcoming mental health strategy by the end of the year. Ministers pledged to strengthen oversight, including regulating private providers via the Care Quality Commission. Health Secretary Yvette Cooper said mental health services need to change to focus more on early support. The review also recommended a clinical review of those on waiting lists to prioritise the highest needs.

Broader mental health trends

Mental distress among young people has risen sharply. One in four 16 to 24-year-olds are now thought to experience it, up from one in six 30 years ago. This rise is driven by conditions like anxiety, depression, self-harm, and eating disorders. The proportion of working-age adults with a common mental health disorder has increased by almost half over the past 30 years.

Population rates of severe conditions like schizophrenia and bipolar disorder have remained stable. The review found frequent overlap between conditions; 61% of 16- to 24-year-olds with a common mental health condition also screened positive for autistic traits, and 57% screened positive for ADHD symptoms. If trends continue, over 4.5 million children and young people could suffer from high psychological distress by 2030. Professor Fonagy linked the rise to increased uncertainty, financial pressures, unaffordable housing, and a lack of hope.

The government is expected to set out more details in its forthcoming mental health strategy by the end of the year.