A major independent review says people should receive help according to their needs before a formal diagnosis, as rising demand and lengthy waits put England’s mental health system under unsustainable pressure.
England’s mental health system is under pressure from rising need, long waits and a growing reliance on diagnosis as the gateway to help, according to a major independent review published by the Department of Health and Social Care on 9 October. The report says the current model is no longer sustainable and urges a move towards what it calls a “needs-led plus diagnosis” approach, under which support would begin according to a person’s difficulties rather than being delayed until tests are complete.
The review was chaired by Professor Peter Fonagy, with Professor Sir Simon Wessely and Professor Gillian Baird as vice-chairs, and follows a government commission launched in December 2025 and an interim paper released in June 2026. Its central argument is that England is facing two failures at once: too many people wait too long for assessment and treatment, while diagnosis has become the main route to services that ought to be available earlier. The authors say help should be offered before, during and after assessment, not withheld until a formal label is confirmed.
The report says mental distress has climbed sharply, particularly among younger people. It points to data showing that the share of adults aged 16 to 64 meeting the criteria for a common mental disorder rose from 15.5% in 1993 to 22.6% in 2024, while the figure for 16- to 24-year-olds increased from about one in six to one in four. Young women now report the highest rates of any group, the review says, while severe mental illnesses such as schizophrenia and bipolar disorder have remained broadly stable. The annual cost of poor mental health in England is estimated at about £300 billion.
On autism and attention-deficit/hyperactivity disorder, or ADHD, the review makes a distinction between underlying prevalence and the numbers being recorded by services. It says the evidence suggests true prevalence has stayed broadly stable or risen only modestly, although England lacks fresh population data. Recorded diagnoses, however, have surged. Between 2000 and 2025, recorded ADHD among 12- to 17-year-olds rose from 0.26% to 3.88%, while recorded autism among 6- to 11-year-olds increased from 0.24% to 4.58%. Demand has risen with it: monthly ADHD referrals have more than tripled since 2019, open ADHD referrals passed 560,000 by the end of 2025, and more than 254,000 people were waiting for autism assessment in December 2025, with most waiting longer than 13 weeks.
The review stops short of saying overdiagnosis is already happening on a large scale, but it warns that the balance of risk is shifting. It says recorded diagnoses in some younger groups now exceed older population estimates, even as the people coming forward are no less affected than those identified in the past. The report also criticises the expanding role of the independent sector, which it says now carries out more than half of NHS-funded ADHD assessments and more than a third of autism assessments. Spending on private ADHD provision has risen steeply, and the review says oversight and quality assurance have not kept pace.
Among its 10 main recommendations, the review proposes bringing all NHS-funded ADHD and autism assessments under regulation by the Care Quality Commission, banning direct-to-public advertising of such assessments, and creating a digital and artificial intelligence-assisted framework to assess and prioritise need. It also wants waiting lists reviewed by clinicians, with a guarantee that no one is removed without being linked to support, plus wider access to evidence-based treatment, better protection for specialist services, regular national prevalence surveys and a public information campaign. The government is being urged to publish a cross-government mental health strategy this year, combining immediate changes over the next 12 to 24 months with a longer reform plan over the next decade.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
