The Fonagy review of NHS England’s mental health, ADHD and autism services was commissioned in 2025 and published recently. The 607-page report warns that without significant transformation, mental health and neurodiversity services face being overwhelmed by demand. The review was initiated due to mounting concerns over escalating waiting lists for assessments, diagnoses and treatment.
The report documents substantial increases in mental distress across the population, which it states cannot be attributed solely to increased awareness. Among 16- to 24-year-olds, approximately one in four currently experience common mental disorders such as anxiety and depression, compared with one in six in 1993. The report indicates that roughly 4 million children are in serious distress, with projections suggesting this could reach 4.5 million by 2030. Self-harm cases could reach 2.5 million across England’s population at current rates. However, rates of severe mental illness such as bipolar disorder and schizophrenia have remained relatively stable, while hazardous drinking has declined. The annual cost of mental ill health is estimated at £300 billion.
Regarding ADHD and autism diagnoses, while the overall proportion of the population estimated to have these conditions has remained relatively stable at 3.8% and 1.2% respectively, diagnoses have risen exponentially. ADHD diagnoses in children aged six to 11 increased more than sixfold in five years, and in 12- to 17-year-olds more than 15-fold. The report identifies a growing risk of misdiagnosis and overdiagnosis, noting that over 560,000 people await ADHD assessment and more than 254,000 await autism assessment. NHS spending on independent-sector ADHD services rose 252% over three years.
Key recommendations include shifting from a diagnostic labeling model to a needs-led service where people can access support through multiple pathways without waiting for diagnosis. The report also calls for prioritizing patients with the highest needs rather than using first-come-first-served waiting lists. Regarding private sector involvement, the government committed to making all ADHD and autism assessments Care Quality Commission-regulated and asked the Advertising Standards Authority to review private sector advertising of assessments.
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