NHS England’s mental health, ADHD, and autism services face being overwhelmed without a radical overhaul, a major independent review has warned. The 607-page report, commissioned in 2025 by then-health secretary Wes Streeting, highlights a substantial increase in mental distress across the population, alongside an “exponential rise” in those seeking assessment for neurodevelopmental conditions.
The extensive inquiry, chaired by Professor Peter Fonagy, concludes that spiralling waiting lists for assessment, diagnosis, and care threaten the National Health Service’s ability to meet escalating demand. It also warns of a significant economic burden, estimating the cost of mental ill-health in England at £300 billion annually.
A central finding of the report is that mental distress has “increased substantially across the population” and is unequivocally real, impacting everyday functioning. The authors state this rise “cannot be explained by greater awareness alone”. Data cited in the report reveals that approximately one in four 16- to 24-year-olds are now thought to experience a common mental disorder such as anxiety or depression. This represents a significant increase from one in six reported in 1993.
Beyond common disorders, the review also notes an increase in cases of self-harm, eating disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and drug dependence. The report estimates that around four million children are currently in “serious distress,” a figure projected to rise to 4.5 million by 2030 if current trends persist. Furthermore, self-harm cases could reach 2.5 million across England’s population at current rates. In contrast, rates of severe mental illnesses like bipolar disorder or schizophrenia have remained relatively stable, and hazardous drinking has declined.
“Continuing as we are is not sustainable,” the report cautions, explaining that this applies to "the people waiting weeks, months or years, becoming more distressed because help is locked behind waiting for a diagnosis; not for those with the most severe needs who cannot access specialist care; and not for a society paying the human and economic price of failing to support people to participate in family, community, education and working life.”
While the estimated proportion of the population with ADHD (3.8%) and autism (1.2%) has remained broadly stable, the report identifies a critical "tipping point" due to a recent exponential rise in diagnoses and the even larger numbers awaiting assessment. Professor Simon Wessely, the review’s vice-chair, indicated that this situation puts people at risk of being misdiagnosed with ADHD and autism.
The figures presented illustrate this surge: the proportion of children aged six to 11 with an ADHD diagnosis has increased more than sixfold in five years, reaching 2.7%. For 12- to 17-year-olds, the increase is even more pronounced, rising more than 15-fold to 3.9% over the same period. The current waiting lists underscore the scale of demand, with more than 560,000 individuals awaiting an ADHD assessment and over 254,000 for an autism assessment. Consequently, the report anticipates a further rise in the proportion of people receiving a diagnosis for either condition.
Despite these rising numbers, the report clarifies: “This does not, by itself, establish that overdiagnosis is currently occurring at scale.” However, it adds: “the evidence suggests we are entering a phase in which the balance of risks between underdiagnosis, misdiagnosis and overdiagnosis may be changing, with the risks of misdiagnosis and overdiagnosis becoming increasingly important considerations for policy and service delivery.”
Concerns were also raised regarding the independent sector’s role in these services. The report found that NHS spending on independent-sector ADHD services increased by 252% over three years. Furthermore, private providers were responsible for more than a third of all NHS-funded autism assessments during the 2025-26 financial year.
Responding to the review’s call for enhanced regulation, Health Secretary Yvette Cooper announced the government’s intention to “make all diagnostic assessments for ADHD and autism Care Quality Commission-regulated”. This measure aims to ensure that "people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers."
Ms Cooper did not commit to an outright ban on private-sector advertising of ADHD and autism assessments to the public. Instead, she stated that the Advertising Standards Authority (ASA) would be asked to review such advertising “to ensure people receive accurate information and are not exploited by companies encouraging them to seek assessments they may not need.”
Professor Peter Fonagy, chair of the review, advocated for a fundamental shift in the NHS approach, moving from a diagnostic labelling model to a more flexible, needs-led system. He emphasised that while “Diagnosis remains essential and must be protected,” the critical change required is that “it is no longer the only door through which help can be reached.”
Under the proposed model, individuals would be able to seek assistance through a broader range of access points, including schools, general practitioners, community services, mental health services, social care, employers, and family hubs. The review recommends that support should be provided at the point of need, rather than being contingent upon receiving a diagnosis. A further key recommendation is the creation of a single, integrated service for mental health and neurodevelopmental support to ensure more joined-up assistance.
In response to the report, the Department of Health and Social Care committed to a significant overhaul of services. The department stated its goal is to ensure “earlier, needs-led support for children, young people and adults, without long waits for clinical diagnosis.”
The review also called for a reprioritisation of waiting lists. Instead of a first-come-first-served approach, mental health and neurodiversity services should ensure that those with the highest needs—such as individuals experiencing self-harm, multiple difficulties, or at risk of imminent school exclusion or unemployment—receive specialist assessment sooner. The authors advised that waiting lists should be "actively reviewed" to facilitate this prioritisation. They also provided assurance that this would not leave individuals with less acute symptoms without access to diagnosis, stressing: “No one should be removed from a pathway without appropriate assessment, communication and discussion.”
