NHS England mental health services review: what has it found and what does it recommend?

Prof Peter Fonagy’s 607-page report is categoric that mental distress has increased substantially and ‘cannot be explained by greater awareness alone’

Full report | NHS at risk of ‘system failures’ as demand for ADHD and autism care soars, inquiry finds

Analysis | No ‘snowflakes’: mental health review says today’s youth have it harder and harms are real

The Fonagy review of NHS England’s mental health, ADHD and autism services was commissioned in 2025 by Wes Streeting, then the health secretary, in response to growing concerns that spiralling waiting lists for assessment, diagnosis and care threatened the NHS’s ability to meet the demand.

1. Unprecedented and growing levels of distress are realThe report is categoric that mental distress has “increased substantially across the population”, is real and affects everyday functioning, and that the rise “cannot be explained by greater awareness alone”. About one in four 16- to 24-year-olds are now thought to have a common mental disorder such as anxiety and depression, up from one in six in 1993, while self-harm, eating disorders, OCD, PTSD and drug dependence have also increased.About 4 million children are in “serious distress”, and if current trends continue that could reach 4.5

3. Overdiagnosis of ADHD and autism is not yet widespread but is a growing riskWhile the proportion of the population thought to have ADHD and to be autistic has remained broadly stable at an estimated 3.8% and 1.2% respectively, the recent exponential rise in those diagnosed, as well as even larger numbers waiting to be assessed, means we have reached a tipping point where people are at risk of being misdiagnosed with ADHD and autism, said Prof Simon Wessely, the review’s vice-chair.The report finds that the proportion of children aged six to 11 with an ADHD diagnosis has increased more than

4. Private companies should be banned from advertising ADHD and autism assessments

Responding to the report’s call for greater regulation, the health secretary, Yvette Cooper, said the government would “make all diagnostic assessments for ADHD and autism Care Quality Commission-regulated, so people can be confident that assessments are high quality and that the NHS is not being overcharged by independent or private providers”.

She stopped short of committing to banning private-sector advertising of ADHD and autism assessments to the public, instead saying the Advertising Standards Authority would be asked to review it, “to ensure people receive accurate information and are not exploited by companies encouraging them to seek assessments they may not need”.

5. The NHS should provide a needs-first serviceProf Peter Fonagy, the review’s chair, said the NHS needed to shift from a diagnostic labelling model to a flexible, needs-led system. “Diagnosis remains essential and must be protected,” he said, but added: “What has to change is that it is no longer the only door through which help can be reached.”Instead, people should be able to seek help through school, GP or community services, mental health services, social care, employers and family hubs. Support should be given at the point of need, not contingent on a diagnosis. And there should be a sin

Waiting lists should be “actively reviewed” to enable that prioritisation. But the authors denied that would leave those with less acute symptoms without any route to diagnosis, stressing: “No one should be removed from a pathway without appropriate assessment, communication and discussion.”