Fonagy review: ADHD and autism diagnoses rising faster than prevalence

A 607-page independent review of mental health, ADHD and autism services in England, published on Friday 9 October, concludes that psychological distress has genuinely risen, while the underlying share of people with ADHD or autism has stayed broadly stable. The review, chaired by Professor Peter Fonagy, also warns that the NHS is struggling with demand and that rising diagnoses are creating a growing risk of misdiagnosis, according to The Guardian, the BBC and the Mirror.

Why the review was commissioned

The review was commissioned in 2025 by Wes Streeting, then health secretary, amid concern that long waits for assessment, diagnosis and care were threatening the health service’s ability to cope. The BBC notes that Streeting had argued young people were being over-diagnosed and written off. The findings could affect NHS services, the benefits system, schools and employment support, the broadcaster adds. The Mirror reports that about 120 experts contributed to the report.

Distress is real and rising

On mental health, the review is unambiguous. It says distress has increased substantially across the population and cannot be explained by greater awareness alone. The Guardian reports that roughly a quarter of 16 to 24-year-olds are now believed to suffer from a common mental disorder, anxiety or depression for instance, against about one in six in 1993. Rates of self-harm, eating disorders, OCD, PTSD and drug dependence have risen too. By contrast, rates of severe mental illness such as bipolar disorder and schizophrenia have remained far more stable.

The BBC reports that Fonagy told the briefing Streeting had been “completely wrong” to suggest over-diagnosis in mental health. The chair links the trend to a mix of factors, including economic uncertainty, social media and the loss of youth services. According to the Mirror, he also argued that young people now have a tougher time, since their lives are less certain and more closely scrutinised, leaving fewer chances to recover.

ADHD and autism: stable prevalence, soaring diagnoses

For ADHD and autism the picture is different. The best estimates put prevalence at around 3.8% for ADHD and 1.2% for autism, and these figures have not materially changed. Diagnoses, however, have climbed sharply. The Guardian says the share of children aged six to 11 with an ADHD diagnosis has risen more than sixfold in five years, to 2.7%, and the share among 12 to 17-year-olds has increased more than 15-fold, to 3.9%.

Behind those figures sits a very large backlog. According to the Guardian and the Mirror, over 560,000 people are in the queue for an ADHD assessment, while over 254,000 are waiting to be assessed for autism. Prof Simon Wessely, the review’s vice-chair, told the briefing that the system had reached a tipping point, after which people become more likely to be misdiagnosed.

The authors are careful, though. They say the evidence does not show that over-diagnosis is happening at scale today, the BBC and the Mirror both report. The warning is about direction of travel: the balance of risk may be moving from under-diagnosis towards over-diagnosis, and the BBC points out that some age groups are still under-diagnosed. It also notes real weaknesses in the data, since the surveys used to estimate how many people are autistic have not been repeated for nine years.

A system where diagnosis is the only door

A recurring theme is that help is too often locked behind a diagnosis. The report describes people waiting weeks, months or years, becoming more distressed while they wait. Prof Gillian Baird, the other vice-chair, said only 14% of people who receive an NHS diagnosis currently get any follow-up care, the Mirror reports, adding that a diagnosis alone says little about the support a person needs.

Fonagy argued that diagnosis must be protected but should no longer be the only route to support. The review calls for a needs-led model in which people can reach help through schools, GPs, community services and employers. It also proposes that everyone on a waiting list is reassessed so those with the greatest need are seen first, rather than strictly in order of referral. Some people with moderate needs could receive support while they wait, and a few might no longer need an assessment at all, the BBC reports.

Private providers and regulation

The report also turns to the independent sector. The Guardian says NHS spending on independent ADHD services rose by 252% over three years, and independent providers delivered over one third of the autism assessments funded by the NHS in the 2025 to 2026 financial year. The Mirror adds that about half of ADHD assessments are now outsourced and that the review warns some may be unreliable.

Responding, the health secretary, Yvette Cooper, said the government would bring all ADHD and autism diagnostic assessments under Care Quality Commission regulation. She did not commit to banning private advertising of assessments, instead asking the Advertising Standards Authority to review it, the Guardian reports.

Reaction and cost

The Mirror quotes Dr Sarah Hughes, chief executive of the charity Mind, who said the findings match what its services have seen for years and that rising need is not the result of a “snowflake generation”. Dr Nick Broughton, NHS England’s director for mental health, called the report a landmark moment and said the NHS is ready to play its part. The review puts the annual cost of mental ill health in England at about £300 billion, including £110 billion for the economy and £60 billion for the NHS.

The recommendations are advice rather than policy, and the government has so far committed only to the regulation of assessments. Anyone worried about their own mental health or about a possible diagnosis should speak to their GP.

Featured image. Source: Wikimedia Commons. Credit: Adrian Pingstone. License: Public domain.