A government-commissioned review led by Prof Peter Fonagy has concluded that the NHS in England faces significant risk of system failures due to mounting demand for mental health and neurodevelopmental care. The 607-page inquiry examined the sharp rise in demand for support across mental health, ADHD, and autism services over recent decades and found widespread challenges in meeting patient needs.
The review documented substantial increases in mental health difficulties across England since the 1990s. Among 16- to 64-year-olds, the proportion with common mental disorders rose from 15.5% in 1993 to 22.6% in 2024, with steeper increases among younger age groups. The data showed that 16- to 24-year-olds experienced the most dramatic shift, moving from approximately one in six to one in four during this period. The authors emphasized that these increases reflect genuine mental health challenges affecting everyday functioning, not merely heightened awareness or resilience issues among young people.
Waiting lists for diagnostic assessments have reached critical levels. At the end of last year, more than 560,000 people in England were awaiting ADHD assessment—17 times higher than in 2019. An additional 254,000 were waiting for autism diagnostic evaluation, bringing the combined total to over 800,000, with nearly all having waited at least three months. Diagnostic rates for both conditions have increased substantially among children, with autism diagnoses in six- to 11-year-olds increasing 20-fold between 2000 and 2025, and ADHD diagnoses rising more than sixfold in five years among the same age group.
The inquiry raised concerns about potential overdiagnosis and inconsistencies in assessment quality, particularly in the private sector. Experts warned that the rapid expansion of diagnoses represents a potential tipping point where misdiagnosis risks are increasing. The review recommended stricter regulation of private clinics, including banning direct-to-public advertising and ensuring all providers meet Care Quality Commission standards.
The report proposed transitioning to a needs-led care model rather than one based solely on formal diagnoses. This would enable individuals to access support based on their requirements rather than waiting years for diagnostic confirmation. The inquiry emphasized that integrating mental health and neurodevelopmental services would better serve patients, many of whom experience multiple conditions concurrently.
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