The Fonagy review of NHS England’s mental health, ADHD and autism services, commissioned in 2025 and published on Friday, concludes that without significant structural changes the system will become overwhelmed. The 607-page report was initiated in response to mounting concerns about extended waiting lists for assessment, diagnosis and treatment across these services.
The review documents substantially increased mental distress across the population, stating this rise cannot be attributed solely to increased awareness. Approximately one in four individuals aged 16 to 24 are estimated to have a common mental disorder such as anxiety or depression, compared with one in six in 1993. The report indicates approximately 4 million children are experiencing serious distress, with projections suggesting this could reach 4.5 million by 2030 if current trends persist. Cases of self-harm could reach 2.5 million across England’s population at current rates. However, rates of severe conditions including bipolar disorder and schizophrenia have remained relatively stable, while hazardous drinking has declined.
The report identifies growing risks of misdiagnosis and overdiagnosis in ADHD and autism assessments. While the estimated proportion of the population with ADHD remains at 3.8% and autism at 1.2%, diagnostic rates among children have risen dramatically, with ADHD diagnoses increasing more than sixfold in ages 6-11 and more than 15-fold in ages 12-17 over five years. More than 560,000 individuals await ADHD assessment and more than 254,000 await autism assessment. NHS spending on private-sector ADHD services increased 252% over three years, with private providers delivering more than one-third of NHS-funded autism assessments in the 2025-26 financial year.
Key recommendations include shifting from a diagnostic-focused model to a needs-led service system, allowing people to access support through multiple pathways including schools, GP services and community resources without requiring a diagnosis first. The report also recommends replacing first-come-first-served waiting lists with prioritization based on clinical need. The Department of Health and Social Care committed to implementing major service reforms, while the health secretary indicated the government would increase regulation of private diagnostic assessments and request the Advertising Standards Authority review industry advertising practices.
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