A landmark 607-page report calls for major reforms to mental health and ADHD services in England as rising demand and long waiting lists place growing pressure on the NHS.
The NHS mental health system is under intense scrutiny after the release of a 607-page report that warns it may be overwhelmed without major changes. The review led by Professor Peter Fonagy states that mental distress has risen significantly across the population and cannot be explained simply by increased awareness. It estimates that by 2030 around 4.5 million children in England may experience serious mental distress.
The report warns that continuing current practices is not sustainable with the annual cost of mental ill health in the UK estimated at £300 billion.
It also notes that while there has been a large increase in ADHD and autism diagnoses this does not necessarily mean more people are affected. The review raises concerns that many people face long waits for assessments and may receive inadequate support after diagnosis. NHS spending on private providers for ADHD services has risen by 252% in three years according to The Guardian.
Private firms accounted for more than a third of autism assessments funded by the NHS in 2025-26. The review recommends banning private companies from advertising ADHD and autism assessments directly to the public to prevent misleading claims.
Professor Fonagy said the NHS should shift away from a diagnosis-based model and instead focus on individual needs. He suggested that support should be available through schools and GPs as well as community services and employers rather than requiring a diagnosis first. Patients with the greatest needs should be prioritized and current waiting lists should be actively reviewed.
The report emphasizes that diagnosis can help explain someone’s problems and guide treatment but it also carries risks. Conditions like ADHD and autism are described as broad spectrums meaning people diagnosed can vary widely in how these conditions affect them. The report states that most people may experience moments of inattention or anxiety or social discomfort at times.
It recommends that support for symptoms such as difficulty concentrating should not depend on a label.
The review also highlights how young people’s lives are increasingly filled with constant comparison and evaluation due to social media and smartphone use. These pressures can contribute to less time for unstructured play and mental recovery. Mental illness among young adults aged 16–24 has increased significantly over the past three decades.
Young women now report particularly high rates of mental health issues. Self-harm and eating disorders have also seen sharp increases in recent years.
The report notes that some people who would have gone undiagnosed in the past are now being diagnosed with ADHD or autism. Health Secretary Yvette Cooper said early intervention is key to addressing mental health and neurodevelopmental conditions. She added that the Labour government has pledged to raise the healthiest generation of children but now must develop a plan to achieve this goal.
Cooper has promised to require Care Quality Commission regulation of private ADHD and autism assessment providers. However she has not committed to the proposed advertising ban and has instead asked the Advertising Standards Authority to review the issue.
Professor Fonagy described his own struggles with mental health during his youth in the foreword to the report. The review’s findings come from input by more than 120 experts and contributors and represent one of the most comprehensive examinations of mental health and neurodevelopmental conditions in England. It calls for a fundamental shift in how mental health services are delivered across schools and the NHS to better support individuals regardless of diagnosis.
The report also underscores that people have often been told their problems are imaginary or in their heads which is untrue. NHS figures show that more than 560000 people were waiting for ADHD assessments in England. Surveys also suggest that around one in five secondary school pupils identify as neurodivergent although self-identification does not necessarily mean a clinical diagnosis.
The review does not confirm overdiagnosis on a large scale but cautions against relying too heavily on labels alone. Its recommendations are expected to help shape the government’s forthcoming mental health strategy for England.
IMAGE: Fonagy in 2008. Photo: Cfonagy / Wikimedia, taken 2008-07-27, Public domain