A government review led by Professor Peter Fonagy has called for radical changes to how ADHD, autism and mental health services are delivered in England. The report warns the NHS is facing system failures due to rising demand, while highlighting significant waiting lists for neurodevelopmental assessments. The government is expected to respond through a new Mental Health Strategy by the end of the year.
A major government-ordered review led by Professor Peter Fonagy has found that the current system for accessing mental health, autism and ADHD support in England is failing. The report, commissioned 10 months ago by former health secretary Wes Streeting, recommends a move towards a needs-led system to manage growing demand. This follows previous warnings regarding the risk of over-diagnosis for ADHD and autism, although the review could not conclude that over-diagnosis is happening on a large scale.
The scale of the backlog is highlighted by figures from The Independent, which reported that 560,000 people were waiting for ADHD assessments in England in December 2025. Furthermore, The Independent stated that 254,000 people had an open autism referral during the same month. These figures contribute to a total of more than 800,000 people waiting for autism or ADHD checks, according to BBC News.
The pressure on services is evidenced by the length of time patients spend waiting for help. BBC News reports that 90% of those on waiting lists for autism or ADHD have waited for more than three months. The authors of the review argue that "The rise in mental health problems is real, is affecting everyday functioning, and cannot be explained by greater awareness alone,"
The report warns that the NHS is heading towards system failures because of this rising demand. It suggests that moving away from a system that depends on a formal diagnosis to access help could be beneficial, as an inaccurate diagnosis can sometimes cause harm. Instead, the review recommends a clinical review of those currently on waiting lists to prioritise individuals with the highest needs rather than using a first-come, first-served method. This follows our earlier report of 9 October 2026.
Data shows a notable shift in the prevalence of mental health disorders among adults over recent decades. According to The Independent, the proportion of adults aged 16 to 64 diagnosed with a common mental health disorder was 22.6% in 2024, compared to 15.5% in 1993. This trend is reflected in younger populations as well, with BBC News reporting that 1 in 4 people aged 16 to 24 are thought to experience mental distress, up from 1 in 6 for the same age group 30 years ago.
The review noted that the distinction between medical and social issues is becoming blurred. This is highlighted by the fact that up to a fifth of pupils in secondary school self-identify as neurodivergent. While autism and ADHD diagnoses are increasing, experts noted to the report that the true prevalence in the general population is estimated to remain broadly stable.
Specific trends in autism diagnoses among children have also been documented. The Guardian reports that 4.58% of children aged 6 to 11 were diagnosed with autism in 2025. This represents a change from the year 2000, when the proportion of 12 to 17-year-olds diagnosed with autism was just 0.1%, according to The Guardian.
The authors of the report provide context for these changing patterns, noting that the rise in mental health issues is a real phenomenon that impacts daily life.
The review has raised concerns regarding the quality and consistency of private sector services. Private providers currently conduct more than half of all NHS-funded ADHD assessments and one third of autism assessments, according to the report. This reliance on the private sector has coincided with a sharp rise in costs for some families.
The Independent reports that the cost of a private ADHD diagnosis has increased by 252% in just three years. To address concerns about oversight, the report recommends that all private assessment clinics should be regulated by the Care Quality Commission. Ministers have pledged to strengthen the oversight of these private providers through the commission.
The report also suggested that there should be a ban on advertising assessments directly to the public, although the government has not yet made a commitment to this specific measure. The findings could have wide-ranging implications for NHS services, the welfare system, schools and employment support across England.
The review's vice-chair and leading psychiatrist, Professor Simon Wessley, addressed criticisms regarding the legitimacy of these mental health challenges, stating, "That’s sometimes been attributed to personal failures, people being told they’re making it up, it's all in their head, which is absolute nonsense,"
The government is expected to outline its response to the findings in a new Mental Health Strategy by the end of the year. This follows the review's call for radical reform of the current support systems. NHS England has already been tasked with looking into how to provide faster treatment, assessments and advice.
Health Secretary Yvette Cooper has commented on the need for reform, stating, "It is clear that mental health services need to change to focus more on the early support young people need to stay in education or work or keep their lives on track."
While the report provides a roadmap for reform, several questions remain regarding implementation. Policymakers will need to decide how to distinguish between those who require clinical care and those who need social support. There are also questions regarding how the government will fund the new service models that the report outlines.
The authors of the review also provided a caution regarding the relationship between traits and clinical conditions. They stated, "Having ADHD- or autism-related traits does not necessarily mean someone has a diagnosable condition,"
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