A comprehensive review led by Prof Peter Fonagy has concluded that the NHS in England confronts significant strain from escalating demand for mental health and neurodevelopmental services. The inquiry, commissioned by the government, projects a “world of system failures” if current trends persist, with particular concern about the growing number of individuals awaiting assessment and diagnosis for conditions including ADHD and autism.
The review documented substantial increases in mental health challenges across England since the 1990s. Among 16- to 64-year-olds, the prevalence of common mental disorders rose from 15.5% in 1993 to 22.6% in 2024, with steeper increases among younger adults aged 16 to 24, jumping from approximately one in six to one in four over the same timeframe. The report countered suggestions that young people exaggerate their struggles, emphasizing that the documented rise in mental distress is genuine and significantly impacts daily functioning. Experts attributed mounting pressures to financial uncertainty, housing affordability challenges, insecure employment prospects, and diminished optimism among youth about their futures relative to previous generations.
Waiting lists have reached critical levels, with more than 560,000 people awaiting ADHD assessment at year-end and approximately 254,000 waiting for autism diagnosis, totaling over 800,000 individuals. Nearly 90% of those waiting had been on lists for at least three months. Diagnoses have increased dramatically among children, with autism diagnoses in 6- to 11-year-olds jumping 20-fold between 2000 and 2025, while ADHD diagnoses in the same age group increased more than sixfold in five years.
The inquiry raised concerns about potential misdiagnosis risks as demand continues accelerating. While finding no evidence of widespread overdiagnosis currently, researchers noted the balance between underdiagnosis and overdiagnosis risks was shifting. The review recommended tightening regulation of private clinics, where many turn due to NHS wait times, and urged movement toward a “needs-led” system prioritizing care based on individual requirements rather than formal diagnoses. The report also called for integration of mental health and neurodevelopmental services to address the common co-occurrence of multiple conditions.
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