An independent review into mental health conditions, ADHD and autism has suggested there is an increasing risk of over-diagnosis, but the picture is complex.
The findings of Professor Peter Fonagy’s independent review into the prevalence of and support for mental health conditions, ADHD and autism have now been published, alongside key recommendations, in a 600-plus page report.
Then-health secretary Wes Streeting commissioned the review in December 2025 after he claimed that young people were being “over-diagnosed” and “written off.”
The review, chaired by Professor Fonagy with Professor Sir Simon Wessely and Professor Gillian Baird supporting as vice-chairs, set out to determine the factors driving trends in the prevalence of mental health conditions, ADHD and autism. It also reviewed the impact of clinical practice and the risks and benefits of medicalisation, ways to promote the prevention of mental ill health and ways to create more resilience among young people and improve early intervention.
It has been described as a “generational opportunity” to rethink support for mental health conditions as well as ADHD and autism.
Review indicates risk of over-diagnosis of ADHD and autism
The report suggests that there is an increasing risk of over-diagnosis in relation to ADHD and autism.
The experts said that a rise in diagnoses over the past 25 years meant that cases now appear to be outstripping the expected number in the population for some younger age groups. For example, among children aged 6-17, more than 4% have been diagnosed with autism, which is significantly higher than the 1-2% that studies suggest should be the true level.
However, the issue is more complex than this.
Firstly, the picture painted by the report is based on weak data. Evidence about the true level of autism relies on surveys conducted over 9 years ago, leading the review team to estimate what has happened since.
Secondly, there are some age groups where these conditions are still being under-diagnosed, therefore blanket assumptions and recommendations should not be made.
Consequently, the review team have said they cannot yet conclude over-diagnosis is taking place “at scale.”
However, the report says there is some evidence to suggest that we are transitioning from an era of under-diagnosis to one of over-diagnosis.
Experts caution that not every challenge requires a medical response and that there is a real risk of blurring the lines between diagnosable ADHD and autism and what they say should be considered the “normal human variation in brain function, cognition and behaviour.”
Rise in mental health conditions is genuine
By contrast, the report emphatically rejects the idea of over-diagnosis in mental health.
Professor Fonagy spoke out ahead of the review’s publication to say there had been a genuine rise in mental distress among young people. He attributed this to a range of environmental factors, including economic uncertainty, the impact of social media and the loss of youth services.
The review highlights that this does not translate to an increase in severe mental illness. For example, population rates of schizophrenia and bipolar disorder have remained stable.
Rather, the rise in mental health conditions is being driven by increased instances of anxiety, depression, self-harm and eating disorders.
Despite debunking beliefs around over-diagnosis of mental health conditions, the review’s authors have raised concerns about the impact of diagnosis. They warn the stigma still associated with these conditions risks holding young people back in education, work and relationships as they could be defined by their “difficulties” rather than their “strengths and potential.”
Around a third of 16-24 year-olds who are not in education, employment or training (NEET) report their mental health or autism as a factor in this.
The review points out that individuals diagnosed with ADHD before the age of 17 are four times more likely to be a NEET than those without. The experts say better support post-diagnosis is required to address this and conclude this support needs to come from the NHS, schools, workplaces and wider society.
Mental health, ADHD and autism review points to system failures
The review team also believes that individuals with mental health conditions and those with neurological conditions such as ADHD and autism are failed by the support system, with long waiting times for assessment.
They found that a third of young people referred to mental health services wait for more than a year, while 90% of the 900,000 people waiting for ADHD or autism assessments have waited for more than 3 months.
NHS Alliance had admitted the system was in “chaos”, but the report says support across care, education, employment and welfare is fragmented, with individuals made to face repeated assessments and conflicting requirements to obtain support.
The review recommends urgent action, including:
- Reassessing individuals on waiting lists so that those most in need are prioritised for help, moving away from a first-come, first-served approach
- Consider whether some individuals waiting could benefit from non-medical support, such as advice about sleeping netter or getting more physical exercise, for example. The review’s authors suggest this could even lead to some individuals being removed from the waiting list
- Better, more robust assessments should be made before people are placed on waiting lists. The experts are clear that not every problem needs a medical solution
- Improve the quality and consistency of ADHD and autism assessments. There are concerns over assessments carried out by non-NHS providers, including charities and private firms, which are not subject to the same regulation. With these accounting for half of ADHD and a third of autism assessments, the review says this needs to change
- A ban on direct-to-public advertising of ADHD and autism assessments
Building a better system
Ultimately, the review concludes that action must be decisive and should be delivered over the next 12 to 24 months to bring real change where it is needed most.
In the Executive Summary, the experts behind the review warn:
“Continuing as we are is not sustainable. Not for the people waiting weeks, months or year, becoming more distressed because help is locked behind waiting for a diagnosis. Not for those with the most severe needs who cannot access specialist care. And not for a society paying the human and economic price of failing to support people to participate in family, community, education and working life.”
They say that, rather than focusing on managing a rise in demand, efforts should be put into building a better system through action to:
- Reduce unacceptable waits now, while reshaping both clinical and non-clinical support
- Taking a serious approach to prevention and wellbeing
- Improving mental health and neurodevelopmental care within and beyond the NHS, particularly in the community
Mental health, ADHD and autism review: over-diagnosis debate misses the point
Crucially, the review’s authors say that the debate about over-diagnosis misses the point entirely as it “risks reinforcing the centrality of diagnosis rather than need and timely access to support and treatment.”
They call for a “fundamental shift from a ‘diagnosis-dependent’ system to a ‘’needs-led plus diagnosis’ system.”
They conclude that the government must address two key failures simultaneously:
- People wait far too long for support, diagnosis and treatment
- Diagnosis has become the primary gateway to support that could and should be available earlier
Responding to the review, the government has committed to “a major overhaul of mental health support in the forthcoming mental health strategy.”
They say this will focus, as recommended, on prevention and early intervention and will be needs-led.
Government pledges improved support for those with ADHD and autism
In relation to ADHD, autism and other neurological conditions, a press release from the Department of Health and Social Care said the government was “seeking to improve support at every stage of life.”
It explains:
“For children, young people and adults experiencing mental distress, greater support will be available in schools, colleges and communities with a focus on earlier intervention, reducing long waits and ensuring support is available before and without a diagnosis.
“Where clinically appropriate, the system will continue to offer timely diagnosis and treatment, such as when someone may require medication.
“As part of this work, the Health and Social Care Secretary has asked NHS leaders to urgently examine how people can access advice, assessments and treatment more easily.
“These reforms will work alongside the government’s new £4 billion package of support for children with special educational needs, backing schools to improve inclusion, widening access to specialist support and rolling out training for every teacher.”
Health Secretary Yvette Cooper commented:
“Professor Fonagy’s review has shown the importance of early intervention to address mental health and neurodevelopmental conditions and the huge distress these can cause. It is clear that mental health services need to change to focus more on the early support young people need to stay in education or work or keep their lives on track. We will set out our response in a new mental health strategy in the coming months, building on the new mental health services we are already providing in schools and in the community.
“Based on the review findings, we will also take action to strengthen the oversight of mental health and neurodevelopmental services, and make all diagnostic assessments for ADHD and autism CQC-regulated, so people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers.”
Responses to the mental health, ADHD and autism review
The Chief Executive of leading UK mental health charity Mind, Dr Sarah Hughes, said the independent review “echoes what we’ve seen across our services for years.”
She explained:
“Increased need for support is not due to a ‘snowflake generation’ or a case of overdiagnosis. Young people are crying out for help with their mental health because of genuine life challenges, and it’s time to listen.
“Our current mental health system is letting young people down when they most need help. Previously the response to rising demand has been more rationing and gatekeeping of support as decades of underfunding has left the system unable to cope. Instead, we urgently need to move to a model of same day open access.
“Providing help earlier prevents needs escalating. The right care, from someone who really sees and understands you, can prevent years of distress and worsening outcomes.
“We welcome the UK Government’s commitment today to provide earlier, more open access support, but long term we need to ensure people can get the help they need on the day they reach out. With the new mental health strategy on the horizon, it’s time to ensure that our system works for everyone. This report needs to be a watershed moment to make the change that people want – and need – to see.”
Meanwhile, the Head of Policy and Influencing at the National Autistic Society also responded to the review.
In a statement published to the charity’s website on 9th October, Mel Merritt welcomed the review’s findings while ensuring the importance of diagnosis for many autistic people was not overlooked or understated:
“This report sets out clearly that successive Governments have failed autistic people. The harm and distress autistic people are facing is real and widespread and there is a desperate need to build a system that supports the needs of autistic people. It’s positive that the Government has finally promised action.
“Autistic people have substantially greater risk of poorer mental and physical health; are much less likely to be in education or employment; and have a devastatingly high risk of suicide. These outcomes aren’t inevitable and it should be a priority to make sure all autistic people can live a dignified life and be part of society.
“The report recommends an overhaul of this broken system to one that gives support to all those who need it while also recognising the importance of diagnosis. The report highlights that a diagnosis has, in most cases, a considerable positive impact. This includes being able to validate and understand your needs, reducing self-blame and being able to find support. It’s right that people should get the support they need when they need it – and, given how important an autism diagnosis can be, have access to an assessment if they want one.
“This reform can only happen with sustained investment and by building the NHS workforce capacity. This will take time and any attempt to move to a needs-led system that abandons those who are currently waiting for an assessment will only increase harm.”
Training and support for youth mental health
First Response Training (FRT) is a leading national training provider delivering courses in subjects such as health and safety, first aid, fire safety, manual handling, food safety, mental health, health and social care and more.
FRT’s specialist mental health training courses include Understanding Mental Health, Mental Health Awareness in the Workplace, Managing Stress, Anxiety and Phobias Awareness, Self-Harm Awareness and Suicide Awareness.
They can also provide qualified, approved trainers to deliver accredited Mental Health First Aid (MHFA) training courses, including the Adult, Youth and Lite versions.
A trainer from FRT says:
“The mental health and emotional wellbeing of children and young people is a huge concern. It’s really important that we all have an understanding of mental health problems and an awareness of conditions such as anxiety, and that we are familiar with effective support strategies for helping others and managing our own anxiety and general mental health, to safeguard our wellbeing. It’s also important for anyone who works with children and young people to understand how to support them with anxiety and help them to look after their mental health and wellbeing.”
Mental health resources
A brief summary of our mental health training can now be downloaded as an infographic.
We also have a number of free infographics available to download which provide simple tips for helping to manage your anxiety and panic attacks. These include:
You can download our free Guide to Mental Health Training from our website.
You can also download FRT’s free Guide To Supporting Young Minds.
Further support for anxiety and other mental health concerns:
- Anxiety UK
- No Panic
- Mind
- Mental Health Foundation
- Rethink Mental Illness
- The Samaritans
- Sane
- CALM
- YoungMinds
Supporting children with ADHD and autism
One way of supporting children and young people with mental health problems, as well as ADHD, autism and other neurodiversities, is to ensure a fully inclusive learning environment.
FRT have recently co-developed a focused training session on Neurodiversity and Inclusive Practice in Education, which will be co-delivered with Experts with Lived Experience and which they have developed and tested extensively in partnership with The Tapscott Learning Trust, an award-winning trust based in London.
The Neurodiversity and Inclusive Practice in Education programme is a co-produced school improvement programme designed to help schools strengthen inclusive practice and improve outcomes for neurodivergent and SEND pupils, whether formally diagnosed or not.
Developed by education leaders and Experts with Lived Experience of autism, ADHD and PDA, the programme supports schools to improve attendance, engagement, wellbeing, belonging and attainment through adaptive teaching, reasonable adjustments and whole-school culture change.
Inspired by the nationally recognised Oliver McGowan Mandatory Training on Learning Disability and Autism, which has trained millions of healthcare professionals across England, the programme combines lived experience, practical strategies, implementation support and impact evaluation to create meaningful and lasting change within education settings.
It also supports schools to develop their Inclusion Strategies and strengthen collaboration with local education, health and care services, helping to create environments where every child feels understood, valued and able to thrive.
Learning outcomes include:
- Explain neurodiversity and common co-occurring profiles
- Recognise early indicators of dysregulation and unmet need
- Understand why autism and other neurodiverse conditions are described as
- Invisible
- Reflect on your own values, beliefs and practice
- Recognise potential differences, strengths and challenges for neurodiverse pupils
- Identify reasonable adjustments and ways to adapt your practice
- Record the impact
Moving beyond awareness to ‘meaningful change in practice’
Perry Leeks, Project Director at FRT, says:
“We were so excited and privileged to collaborate with members of the neurodiverse community to develop a special programme for the education sector that specifically addresses a very real need, meets key criteria outlined in the Schools whitepaper, and helps teachers reflect on and enhance their practice and the support they offer.”
Daniel Mansfield, Training Hub Director at The Tapscott Learning Trust, added:
“One of the most powerful aspects of this programme is that it moves beyond awareness and focuses on meaningful change in practice.
“Throughout the pilot phase, we saw staff develop a deeper understanding of neurodiversity, reflect honestly on the barriers pupils face and identify practical adaptations that could be implemented immediately.
“The ‘One Child in Mind’ approach helps bring the learning to life, ensuring discussions remain rooted in the experiences of real children rather than abstract theory.
“What stood out most was the impact of learning directly from Experts with Lived Experience, which consistently challenged assumptions, increased empathy and inspired action. Schools left not only with greater confidence and understanding, but with tangible plans to improve inclusion, strengthen relationships and create learning environments where all children can thrive.”
Download our flyer to find out more about Neurodiversity and Inclusive Practice in Education.
For further information on other types of neurodiversity training, visit FRT’s webpage or download the brochure.
You can contact FRT via freephone 0800 310 2300, send an e-mail to info@firstresponsetraining.com or submit an online enquiry.